HomeMy WebLinkAbout2713 Silver Creek Dr - Applications/Furnace - 08/15/2017City of Planning, Development & Transportation
r 281 N. College Ave P.O. Box 580
Collins 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)" o Lg
Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lightr ❑ Gas g
`Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑Sewer Line e❑ Photo -voltaic
❑ Ventilation ❑ 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 # >I 3U %-7 ! 10 I Date
e
For office use only r
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Job Site Address (required)
Property Owner Name
Name
Tr co010
Address
Address
Contractor_ A?r-Address
.,T L.AIA
�.Ftractor City of FL Collins Sales Tax #
fax number is required by all contractors
C-0 Value of Constn?ction (labor,
_ -
City/State Zip Phone
r ice. I
City/State , Zip Ph ne
Zip
Are you paying taxes here or by report? tkHere ❑ Report
Are you paying with your trust account? ❑ Yes )QNo
Is this a residential oYSjgle
inertial project? idential ❑ Commercial
If residential, is it:nFamily Detached ❑ Condo/townhome (single family attached) ❑ Duplex
ultifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Mptel M ��ical office ❑ Office El Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑Yes ❑ No If yes, you mayneed�o Hislr�n`cpfeservation
If this is for a demolition permit, what year was the building constructed? 4/ \
Ifprior to 1975, you will need an asbestos assessment to submit with this app/icabon.
Of
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Col/ins license #
Electrician plumber MechamcaRoofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree bD
comply with all requirements contained herein and city ordinances and state laws regulabng building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant
Print Name: 1l 1�� CI t 1 y 1 Signatu�j02/ -