HomeMy WebLinkAbout2713 Silver Creek Dr - Applications/Furnace - 08/15/2017 (2)Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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).kAir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
VHeatng Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing -0 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 on the application. Incomplete applications will not be accepted
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Application #pjl�0��-loi�7 �-jl =�b�8 Date
For office use only P� I '0-T9
Job SiteAddress (required) � ®O `l M Ca
Value of Con 11n (labor, materials rod)
Property Owner Name Address
City/State Zip
Phone
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FplTint Name Address
City/State , Zip
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Phone
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Contractor <-LPb401 % �ftVt--) � Xv-Address
City/State Zip
Phone
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Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report?
l0ere ❑ Report
Sales tax number Isregmredbya#canbadom Are you paying with your trust account?
❑ Yes *'�ANo
Is this a residential or mercial project? �B
If residential, is �: Single Family Detached
Multifamily (apartment)
sidential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Garage
If commercial, is it. ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ��M ical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain) j� \
Is this building 50 years of age or more? O Yes O No Ifyes, you may need�o( actHWORCVieservatfon
If this is for a demolition permit, what year was the building constructed?
IfpH'or to 1975, you will need an asbeslos assessivent to submit with this appIl
Of
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*If lawn sprinkler/backflow preventer, must list licensed plumber If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or aty of Ft Collins license#�
Eedndan �Pej"ew� (,
�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 Huth 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: �k� l IY�I�V Print Name
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