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HomeMy WebLinkAbout713 Columbia Rd - Applications/Furnace - 06/27/2016From 06/23/2016 06:16 0235 P.002/002 FCiof lirt Collins Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 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 -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 #_61bo35;­-4-4 For office use only Date C0 Sob Site Address (required) Value of Construction (labor, materials, profit) Property Owner Name Address City/State Zip Phone Applicant Name Address City/State Zip Phone Contractor Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? IfHefe *Report salestax number isrequired by, all contractors. Are you paying with yourtrust account?'XYes C1 No Is this a residential or comrercial project? k1kesidential ❑ Commercial If residential, is it: Ingle Family Detached .Condo/townhome (single family attached) ❑ Duplex Multifamily ❑ (apartment) 0 Garage If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? . ❑ Yes 0 No 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 wil/need an asbestos assessment to submit with this application. Description of *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time NC, must list licensed electrician. Subcontractors: List the company name or City of Ft Collins license 9 Electridari 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 ha's been paid and issued. Applicant: Print Name: ` `�(. \ signature. i Na..a ;CA,. a (n17—,4lr