HomeMy WebLinkAbout824 Benthaven St - Applications/Furnace - 08/21/2017c_City of Planning, Development, & Transportation Services
�"VI t oUinS Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax. 970.224.0134
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
't Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voltsic
❑ Ventilation 13 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*_ � `�D�-� �� Date _ ��Z--I A-7
For ofte use m*
o Site Address (re9uzmd) Valuq of Constructionlabor, materials, profit)
roperty Owner Name Address City/State Zip AV ne
Applicant Name Address City/ate Lp Phone
Fort Collins Heating & Air 208 Commerce. Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor Address Gty/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here
Saks tax nunW is repetnd by 0 cnnbacevs Are you paying with your trust account? V Yes ❑ No
Is this a reskiential or mercial project? NResidential 0 Commercial
If residential, is it: I hS ftk Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
13'Mulfifarrgly (apartment) O Garage
If commercial, Is it: 0 Bank ❑ Bar O Church 0 Hotel/Motel ❑ Medial office 0 Office 0 Rail
0 Restaurant 0 Other (explain)
Is this building 50 years of age or more? ❑ Yes No If yam. you may need to contact H&M* f4es>?wd n
If this is for a demolition permit, what year was thie building constructed?
Description of work
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must gst licensed electrician.
Subcontractors LAt the company name or 01Y offt CoHns /kerm s
qua mechanto&L H1309 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 slate laws regulating building construction. I know that a
permit Is not valid until It has been paid and blued.
Applicant:
Print Name [ �,Y ` Signature l Date
RevWan dft2i 017