HomeMy WebLinkAbout5223 Paradise Ln - Applications/Furnace - 04/11/2017From
04/11/2017 05:28 *568 P.002/003
City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F.�ort Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to Pe 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
1044eating 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 in'ffoor(m�atiioon on the
japplication.
Application # ��,./ il + " O a+
For o>pce use only 1T
Incomplete applications will not be accepted.
Date 4`1.:4�� Ii_7
Job 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?
WfHere 411eport
Sakes tax riamberisrequiedbya#conftartors
Are you paying with your trust account? AYes Q No
Is this a residential or commercial project? b esidential ❑ Commercial
If residential, Is it: Q37ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank 17 Bar 0 church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
O Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes 0 No If yes, ytw may need to contact Historic preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, yvu M// need an asbestos assessment to submit with this appl/cation.
Description of work
"If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or Gty 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:
Print Name:�\ItO\e Gt k� Signature. . �i\ �+..� I y
-- Date 1':