HomeMy WebLinkAbout326 S Grant Ave - Applications/Furnace - 08/10/2017From:
08/10/2017 03:37 0709 P.001/001
City of
Fort Cottins
Planning, Development 8: Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 8052-4
..Phone 970-416-2740 Fax 224-6134
This application is td,be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
O Demolition (interior non-structural) D Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
Ventilation ❑ Water Heater CO Water Line 0 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 #
for office use only
Date�k�� 1
lob Site Address (required)
Value of Construction (labor, materials, profit)
S C
Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? I(Hefe
*Report
Sales tax number is required by all contractors
Are you paying wr your trust account? K Yes
13 No
Is this a residential, r mmercial project? -Residential ❑ Commercial
If residential; is it: Single Family Detach ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) 0 Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O No If yes, you may need to contact HHistonc 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
•'tt lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the comnany name or Gty of h7 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: h•
Print Name: C��ta\Q -7:% Q �'Aw+ Signature • • N� Date