HomeMy WebLinkAbout1600 Dogwood Ct - Applications/Furnace - 06/05/2017> / 31 / W- 1-i0171 1 f:MM AMFXRT TO : 18702246134
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FROI�i, 41SAV07234
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T-8YY P 00i W : F-5575
ISO VCNA
Planning, Development & Transportation
281 N. Collage Ave P.O. Box 580
Fort Collins, 00 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This apprW40on Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-sbudural) 0 Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
❑ Healing Unit ❑ lawn Sprinkler ❑ AMoble Home replacement ❑ Roofing 0 Sewer Line 0 photo -voltaic
❑ Ventilation ❑ Water Heater 0 Water Line 0 WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete an applk:able Information on the application. Incomplete applications will not be accepted.
Application # .1)9 w bate
Far oAitir use only
Me Addi=ii (twtu a(t
Value of Construction (labor, materials, profit)
b
Property Own& Name Address
City/State Zip
Phone
q1o,4q%.4no
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Fort Collin
Dr. #4 Fort Collins,80524
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report?
0 Here 0 Report
.slisa rnrmrae,lsieWAvdayaUm*a mrs
Are you paying with your trust account?
❑ Yes 0 No
Is this a residential or mpt nerdal project? 15114tesidential ❑ Commercial
If residential, is it: ErSIngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If eomrrmclai, is it: ❑ Bank ❑ Bar ❑ church ❑ Motel/Motel 0 Medical office 17 Office O Retail
❑ Restaurant ❑ Other (explain)
Is this buildmg log yearsof age or morel O Yes O No Ifyes, you may need to contactHistnn'c Prese"hon
If this is for a demolition penult, what year was the building constructed?
lfpmr to 1975, ynu still need an as iestns assessment lo satan/t WO this app/irabon.
Deso ption of work
*If lawn sprinift/tixidlow preveneea, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors; 1W tie a rijawy name or d1'y of fi' a&w Lcww 0
Electrician Plumber Madharncai H92 Roofer other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
emnply with all negwremeMs con [nod herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until R has been paid and issued
Prhkt Name:
Pe: Amge]$ Morrow Signature
Data ���.� I / / %