HomeMy WebLinkAbout1015 Nightingale Dr - Applications/Furnace - 08/23/2019FCity of,. Planning, Development, & Transportation Services
ort CoU!ns Community Development & Neighborhood Seivices
281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 Fwc 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-vomc
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # P/0 0b'309
roran2ba- early
Date August 23, 20.19
Job Site Address (required) Value of Construction (labor, materials, profit)
1015 Nightingale Drive, Fort Collins, Colorado 80525 $7750.00
Property Owner Name Address City/State Zip Phone
Coral MGC" 1636 Edwards Dr Point Roberts, WA 98281 360-945-2117
Applicant Name Address City/state itpp Phone
Christina Evans 1015 Link Lane Ft Co, CO 80524 494-7632
Contractor Address aty/State Zrp Phone
Allen Service 1015 Link Lane Ft Co, CO 80524 484-4841
Contraitr City of FL Collins Sales Tax # Are you paying taxes here or by report? [],Pere ❑ Report
,WwtarnumberereQretdbya#cunftac m Are you paying with your trust acoounV 4 Yes ❑ No
10010
Is this a residential or menial project? Residential ❑ Commer®1
If residential, is it: VI Single Sam ly Detached ❑ C.ondo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If mmmeraal, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office O Office ❑ Roil
❑ Restaurant ❑ Other (explain)
is this building So years of age or more? ❑ Yes ❑ No Yves. you mayneed to mntac hE,;ty c Preswmdan
If this is for a demolition permit, what year was the building constructed.
Description of work. Pzm w e rtug F " "° Mli rRh new like Formes
*If lawn sprinkler/badc0ow preventer, must list licensed plumbs: If first-time A /Cry must list licensed electrivan.
Subcontractors: L& ft cwnpany nam or My off tCQl6w&s7.ore#
Sectridarl Pfwnber Mechanical Roofer Other
I hereby acknowledge that I have read this app5ration and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid aritil it has been paid and issued.
Print Name: Ch+i4twia.Eva n6 54gnature S .il i t wm C/Vi/lii lsb Date
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