HomeMy WebLinkAbout918 Marble Dr - Applications/Furnace - 11/15/2016From:
11/15/2016 06:58 #390 P.001/002
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1. City of
F or-t Collins
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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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
V 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 VMWX Date
For office use only
Job Site Address (required) .
Value of Construction (labor, materials, profit)
53
Property Owner Name Address
City/State Zip Phone
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Applicant Name 0 Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? WHere *Report
Sales tax number a required by all contractors
Are you paying with your trust account? X Yes it No
Is this a residential.or commercial project? residential ❑ Commercial
If residential, is it: Single Family Detache ❑ 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 s 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 will need an asbestos assessment to submit with this application.
Description of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must Ilst licensed electrician.
Subcontractors: List the company name or City of Ft Collins license 0
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: �•
Print Name:.` `LLDN - GM. ONTY'�- Signature,,,",��, � . � — Date _kv�<J