HomeMy WebLinkAbout1609 E Pitkin St - Applications/Furnace - 09/30/2016iPlannjhq, ;Developmant & Transportation
981 N. College Ave P.O. Box 580
Fort Collins, CO 8052,11
Phone 970-1116-2740 Fax 224-6134
`[t/ VY3i:5 - JI H - A RTER PERMITS ONVI
This application is to be used to apply for the following permits only (check ail that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
�1-leating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement El Roofing El Sewer Line ❑ Photo -voltaic
CI Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, modal and
manufacturer).
complete all applicable information on the application. incomplete applications will not be accepted.
Application # 61 b 05 Gog Date
1' Far nffne use only
3ob Site Address 0-equirad) Value of Construction (labor, materials, profit)
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er t Owner N e Address City/State _Zip Phone
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A olicant Name Address City/State Zip Phone
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Conti actor . Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑Here Report
=�,tes rsk number & required byal' contactors Are you paying with your trust account? 'Dyes ❑ NO
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Is this a residential or commercial project? Residential ❑Commercial
if residential, is it: �rngie Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
CI Multifamily (apartment) ❑Garage
If commercial, is it: ElBank ❑ Bar ❑ Church ❑ Hotel/Motel ❑Medical office El Office ❑Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes 11 No Ifyes, you mayneed to contact flistoricPreservatlon
If this is for a demolition permit, what year was the building constructed?
Yr/ior to 1975, you w!U n ed an asbestos assessment to submitw! this appilcation.
DTe�scrip%lion work
i — acicflow reventer, must list licensed plumber. TF first time A/C, must list licensed electrician.
If lawn sprinkler/b P
Subcontractors: List the company name or City offt collins Acense i#
l Gcclrician—_
Plumber Mechanical Roofer _. Other
f 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 hnouv that a
permit is not valid until it has been paid and issued.
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App,rcant:
Print Nam D�IGSSignatura axe!-------