HomeMy WebLinkAbout2709 Canby Way - Permits/Water Heater - 10/23/2017�CityOf Planning, Development, & Transportation Services
�, ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main 970416 2740 Fax 970 224 0134
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
O Heating Unit Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voftaic
❑ Ventilatio 3WIliter Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufactu
Complete all applicable information on the application. Incomplete applications will not be accepted
Application # 611 D 1 I Rit-1
For oh/te use only
Sob Site Address (reau/7edu
Date sblZ 11
Value construction (labor, materials, profit)
. Llc Tn t1yin
Owner Name v J Address
^ N"Z' \d _City/State Zip
Applicant Name Address Gty/S to Zip Phone
Fort Collins Heating & Air 208 Commerce Dr #4 Fort Collins, CO 80524 970 484.4
Contractor Address
City/State Zip Phone
ruri Lomns Meabng & Alr 208 Commerce Dr #4 Fort Collins CO 80524 970 484 4552
Contractor City of R.
Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
S31es taxnt mbw is by all mneacAxs Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Ziesidential ❑ Commercial
If residential, Is it. )2r&ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it. ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office a Retail
❑ Restaurant ❑ Other ( cal )
Is this building 50 years of age or more? ❑ Yes If yes, )vu mayneed m contact H7stoncPresl°rvabon
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backRow prevalter, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontracors: List the company name or City of fr Collins lkense j'
Electrician plumber Mechanical H1309 Roofer
Other
I hereby acknowledge that I have read this applkation and state that the above Information is complete and correct I agree to
comply with all requirements oontained 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.
i Signature Date 2%
Revolm date 2SO17