HomeMy WebLinkAbout306 Sundance Cir N - Applications/Furnace - 08/08/2017�.FCitY of Planning, Development, & Transportation Services
Ort Collins Community Development & Neighborhood Services
•— 281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 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-structuraq ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Ph 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 on the application. Incomplete applications will not be accepted.
Application # I HIV �� C1 4 pate a W_ l 7
For oft a use only
Sob Site Address (required) Value,gf Construction (labor, materials, profit)
Prqperty Owner Nayne 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 aty of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 0 Report
sales tarn&nber/s a# av&actam Are you paying with your trust account? * Yes ❑ No
Is this a residential or commercial project? IdResidential ❑ Commierdal
If residential, is It: % Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
H commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ petal
❑ Restaurant ❑ Other (explain)
Is this building 50 yearsof age or more? ❑ Yes o No If yes, you may need to contact H&twk Premuvabon
If this is for a demolition permit, what year was the building constructed?
Description of Work
*If lawn sprinkler/baddlow preventer, must ast licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Lbt the company name or pry of f? Collins Abmw #
QectriNan Plumber. MechanioL H1309 Rpp{g 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: �/��
Print Name {,1(,1( Signs —19" � --Date
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