HomeMy WebLinkAbout1368 Village Park Ct - Applications/Furnace - 05/24/2017City of
For! 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ 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 Inf(o'rrm, atio�n(on the a placation. Incomplete applications will not be accepted.
Application'# vt/)(0
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For office use onty
Job Site Address (rwuired)
Value of Construction bor, materials profit)
al
Property Owner Name
Address
City/State Zip
Phone
;3-L r
Ap Iican t Name
Address
City/State Zip
Phone
X)501
10
Contrador
Address
ty./wState Tip
Phone
l�.�r I r of
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Contractor City of Ft Collins Sales Tax it
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tar number Is requ#W by all mnbacwm
Are you paying with your trust account?
❑ Yes k90
Is this a residential or commercial project? %Residential ❑ Commercial
If residential, is it: Congle 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 budding 50 years of age or more? 0 Yes Oo If yes, you may need to contact Histvdc Pteservatbon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit wKh aria appl/cabon.
Description of work r PZ11acAt �-
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of R Collins 1/tense 0
Electnaan Plumber Mechanic hl%4 Roofer Other
I hereby acknowledge that 1 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.
� nt Name: MLql9 6 r ilk Signature &141A �t1C U Date t��
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