HomeMy WebLinkAbout316 S Grant Ave - Applications/Gas - Log, Line, Pipe - 08/28/2017FCity of Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.418.2740 Fax 970.224.6134
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 information (onn the pplication. Incomplete applications will not be accepted.
Application # S 1 ] 0 �y(,7 Date O
For oSkr use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
�). t
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970,484.4552
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here �r{y Report
sales tax number israpupedbyaNcnnbactars. Are you paying with your trust account? Yes ❑ No
Is this a residential or commercial project:? 4 Residential ❑ Commercial
If residential, is it: IX Single 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 O Other (explain)
Is this building 50 years of age or more? O Yes O No If yes, you may need to contact Histon`c Preservation
If this is for a demolition permit, what'year was the building constructed?
Description of work UplclroS
*If lawn sprinlder/ oackflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Oty of Ft Collins license #
Electrician Plumber MechaNml 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 dty ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and Issued.
Applicant: Q
Print Name: Y Signature Date O
Rwilim date ZSM017