HomeMy WebLinkAbout849 Juniper Ln - Applications/Furnace - 08/15/2017Fort ttCollins
Manning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CD 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 Air Conditioning
O Demolition (interior non-structural) 13 Electrical Alteration (not service change) O Gas Lighter ❑ Gas Log
D Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement O Roofing O Sewer line O Photo -voltaic
O Ventilation O Water Heater O Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Inforr. n on the application. Incomplete applications will not be accepted.,.o
Application # / i( / Date
For dffw ase onb, ,� 1 7aq
Sob Site Adders (mquHed)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip Phone
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Applicant 16me Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
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Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? )3f Here ❑ Report
Saesaw, wmbe-Isreqzwedbyaravurdoors
Are you paying with your trust account? O Yes O No
Is this a residential or commercial project? PIResideatial O Commercial
If residential, Is it: OSingle Family Detached O Condo/townhome (single family attached) O Duplex
17 Multifamily (apartment) O Garage
If commercial, is it: D Bank O Bar. O Church O Hotel/Motel O Medical office ❑ Office ❑ Retail
O Restaurant 0 Coker (explain) r
Is this building 50 years of age or more? O Yes O No If yes, you ney need to contactHistoric Preservabron
If this Is for a demolition permit; what year was the building constructed? I
Ifpnbr to 1975 you W// need an alas asseswwt to si&nW WM this ap lAwhon.
Description of work
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: list the company name or CRy of R Collins //cww 0
ien•id�F� . <, Plumber Medhardol 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 state laws regulating building construction. I know that a
permit is not valid until it has been paid and Issued.
i
Applicant:
Print Name: Yi' Signature r Dam /5 /
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