HomeMy WebLinkAbout525 Breakwater Dr - Applications/Furnace - 10/27/2017_FCity of Planning, Development, & Transportation Services
irt 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-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
A 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 #
fb ii-o-i ► as
For office use only
Date
lob Site Address (mqu/red) Value Construction (labor, materials, profit)
JR
Property Owner Name 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 City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 0 Report
"es tax number is requir W by all contractors. Are you paying with your trust account? 4 Yes ❑ No
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: 611 Single 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 (e)plain)
Is this building 50 years of age or more? ❑ Yes t4No tf yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or Gty of Collins license #
Filectiician Plumber Me&anical H1309 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 constriction. I know that a
permit is not valid until It has been paid and Issued.
m l
Applicant: It lb� 1 Signature Date 23
Print Name:
RMISM date 24=17