HomeMy WebLinkAbout3002 W Elizabeth St - Applications/Furnace - 06/14/2016From
06/14/2016 08:41 #217 P.006/006
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). Q�kjr Conditioning
-❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
bleating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater C7 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 # UP08q-7 d Date �r 1
For office use only
Job Site Address (required) Value of Construction (tabor, 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? (IrHere .Report
Sales tax number cs required by all contractors Are you paying with your°trust account? ,Yes Q No
Is this a residential or commercial project? b4iesidential . ❑ Commercial
If residential; is it: `E25ingle Family Detached ❑ Condo/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 age or more? ❑ Yes 13 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 will need an asbestos assessment to submit with this applicadon.
Description of work
*If lawn sprinkler/backtiow 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 #
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: f� 1
Print Name: Signature (� . ice,__ t ,.
-�1�t A .A Date 'I