HomeMy WebLinkAbout1945 Fossil Creek Pkwy - Applications/Furnace - 11/17/2017tCity of Planning, Development, & Transportation Services
ort 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
1 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 applic oiLbea
VA
Application #_ I �� �Q� Date
For afte usa° arty
lob Site Address (&vidrsd) Value of Con labor
Property Owner Nam Address City/State Phone
-NAMWM ffir, ,
Applicant Name Address City/to 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 HeahnA & 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
Seiler brnwnbw&fegl*vtdb 8acmaaarws Are you paying with your trust account? ■ Yes ❑ No
Is this a residential or commercial project? ! Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ■ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commeraal, is it. ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Offioe ❑ Retail
❑ Restaurant ❑ Other (explain)
is this building SO years of age or more? O Yes ❑ No If yes, you may need to contact Hlslonc P2serva0ron
If this Is for a demoitdon permit, what year was the building constructed?
Descriptlon of work r
*If lawn sprinlder/backnow preventer, must list licensed plumber If first-time A/c, must list licensed elecbldan.
Subcontractors: List G6e company name or aty of Ft CollIns Ikense cif
Ekvriidan 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 contalned herein and dty ordinances and state laws regulating building construction I know that a
Permit Is not valid until It has been paid and Issued,
Applicant: Crl 1
Print Namex signature Date