HomeMy WebLinkAbout1706 Rushwood Ct - Applications/Furnace - 10/18/2017Fcity of Planning, Development, & Transportation Services
eort 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
)I 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 inforrnation on the application. Incomplete applications will not be accepted.
Application # Date
For office use only
Job Site Address (requited) Value of Co tructi�on (labor, materials, profit)
Property ner Na ac�Address City/State Zip Phone
5�
-10
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 R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report
Sales tax number is required by all contractors Are you paying with your trust account? 0 Yes ❑ No
CU
Is this a residential or commercial project? N Residential ❑ Commercial
If residential, is it: N 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 (explain)
Is this building 50 years of age or more? ❑ Yes [rA No 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
*If lawn sprinkler/backtlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orOtyofRColllnslrcense#
Electrician Plumber Mechanical 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 construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: lhn1 C
Print Name: 1,1 �C Signature Date
Revision dWe 2A 2017