HomeMy WebLinkAbout5828 Venus Ave - Applications/Furnace - 08/01/2016Pizinning, Development z T ransportatian
281 N. College Ave . P.O. Box 580
Fort: Collins, CO 80524
Phone 970-=i16-27'}0 Fax 224-613 �l
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T,ris application is to be Lis ad to apply for thafolloviing permits Only (check ail chat apply). ❑ Air Conditioning
De no!ition (interior non-structural) ❑ Electrical Alteration (not service change) ❑Gas Lighter El Gas Log
I leating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
�_, Veniilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
nlainUfaCtUrer).
coiliplete all applicable information on the application. incomplete applications will not be accepted.
Application ,r1 l • — Date
For office U5e only
fob Site Acic ra$s (ieguir?d) Ilalup oaf .Construction (labor, materials, profit)
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p oyerty Owner Narnne T Address City/State Zip Phone
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A plicant Name.. Address City/State Zip Phone
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Contractor: Address City/State `Lip Phone
Contractoi City of l=t. Collins Sales Tax ;� Are you paying taxes here or by report? ❑ Here -gReport
s:i 7 tit i1umberi-sroquirodbyall cvntractors Are you paying with your trust account? '' Yes ❑ No .
^ Is this a residential or commercial project? Pd
Residential •❑ Commercial
l r i esic!ential, is it: Single Family Detach ❑ Condo/townhome (single family attached) ❑ Duplex
tl Multifamily (apartment) ❑ Garage
If con,unercial, is it: ❑ Banl< ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is tliis building So year's of age or more? ❑ Yes ❑ No rfyes, you mayneed to contact /yistoricPmservadon
If this is for a dernolition perrnift, what year was the building constructed?
_rf error to 1 _q75, you aviil nod an asbestos assessrnent to submit with this application.
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Description of
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`" If lawn spi-inklei/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companynameorCity ofFtCol/ins license
[:Icctrician_
Plumber Med7anical Roofer Other
r horeby acknowledge that I have react 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. 3 knovi that a
perr77it is not valid until it has been paid and issued.
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Pr•intName—i signatra,a /�, ate-- -----