HomeMy WebLinkAbout2850 Autumn Harvest Way - Applications/Furnace - 03/22/2016From
03/18/2016 03:01 #092 P.002/006
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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
O Demolition (interior non-structural) Cl Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ 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 # I �O C'� I - �2 b Date
For ofte use only
Is this a residential or commercial project? C�tesidenttal ❑ Commercial
If residential, is it: Ingle Family Detached ❑ Condo/townhome (single family attached) D Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retaii
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes ONO If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you w111 need an asbestos assessment to submit with this APp/ication.
I —
Description of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list license ician.
Subcontractors: list the company name or City of Ft Collins license #
Electrician Plumber Mechanical
Roofer Other
I hereby 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
permit is not valid until it has been paid and issued.
Applicant: h'
Print Name: C. nature Si N __
g �t.� � Date