HomeMy WebLinkAbout7318 Streamside Dr - Applications/Furnace - 09/06/2017From
09/06/2017 06 32 #731 P 001/002
FCity of
�1`®Ol_
Planning, Development & Transportation
281 N. College Ave P.0 Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is tope used to apply for the following permits only (check all that apply). ttir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Ueating 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 # �� -05 � ` Date
For ofte use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip Phone
3-
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
a
Contractor City of Ft. Collins sales Tax #
Are you paying taxes here or by report? WHere *Report
Sakstax manderaregimedbyaucmaactors
Are you paying with your trust acmunt7 KYes t01 No
Is this a residential or commercial projects `Residential ❑ Commercial
If residential, is it. t�$Ingle Family Detach ❑ Condo/townhome (single family attached) ❑ Duplex
L1+ Multifamily (apartment) ❑ Garage
If commercial, is It- ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or mores ❑ Yes ❑ No If yes, yvu may need W contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you w111 need an asbestos assessment to submit with this application
Description of work
*If lawn sprinkler/bacidlow preventer, must list licensed plumber If first-time A/C, must list licensed electrician.
Subcontractors: Last the company name or Cry of Coffins lxense 0
ElecMoar 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: t1• /� t� Print Name `\�C��O Gmk. mM Signature, J i`A 164 Date