HomeMy WebLinkAbout619 Meadow Run Run Dr - Applications/Furnace - 09/18/2017City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F6rt Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 1 �� , J�
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 on the application. Incomplete applications will not be accepted.
Application # (� I76 S�g3 Date q -/8 -/ 7
For office use only
Is this a residential or commercial project? AResidential ❑ Commercial
If residential, is it: >CSingle 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 ❑ Other (explain
Is this building So years of age or more? ❑ Yes KVo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Replace 50j -Arced av furacr e 'rgs&l ai/'-r;ltl4(
e - I %--
"If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician 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 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: $04A1 e_ 4LX 4 Signature Date