HomeMy WebLinkAbout2421 Chandler Ct - Applications/Furnace - 01/12/2016Planning, .Develop3nent .8z Tmansportation
281 N. College Ave P.O. Sox 580
I Collins, CO 80524
Phone 970-416-2740 Fax 224-613=1
This application is -to be used to apply for the :oliowing permits only (check all that apply). ❑ Air Conditioning
11 Demoiltion (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
-leating Unit ❑ Lamm Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
�l ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicabla information on the application. Incomplete applications will not be accepted.
Appllu-atlon ;r ?�I o5146 Date /_ 24(a _
For of rce use only
3ob Sit... AJdress (requiizd) Value of -Construction (labor, materials, profit)
operty Owner Nam.n Address City/State Zip Phone
Applicant Name, Address City/State Zip Phone
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Contractorn Address City/State Zip Phony
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report
alza t%numborisrequiredbyallcontracctors. Are you paying with your trust account? •'i -Yes ❑ No
Is this a residential or commercial project? Residential El Commercial
If residential, is it: Single Family DetaclAd ElCondo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of aga or more? ❑ Yes ❑ No Ifyes, youmayneed to contact Historic Preservation
if this is for a demolition vermat, what year was the building constructed? _
.If Avfor to 1975, you Will r/,eed an asbestos assessment to submit w�this application.
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Description or work
14If lawn sprinkler/backflow preventer, must- list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license r0
EIcdilban—__ _ Plumber_ Mechanical Roofer _ Other
I horeby acknowledge that I have read this application 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
pernilt is not valid until it has been pair] and issued.
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Applicant: ; �
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