HomeMy WebLinkAbout2261 Smallwood Dr - Applications/Furnace - 12/18/2017From: 12/18/2017 09.27 #842 P 003/003
Cit of
Fort Cot[ins Planning, Development, 8 Transportation Services
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), BWr Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
\qPHeating 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 �((noonnth application. �Inn(complete applications will not be accepted.
Application # I I v U � U � I�`(J� Date _ Va..\XA`i i
f & ark a use only
lob site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
-1
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Cher
'Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? Mere ❑ Report
Saks iaxnumbe-/5rewuredbyammraaCWM Are you paying with your trust account? WYes ❑ No
3t�rs
Is this a residential or commercial project? %�% idential ' ❑ Commercial
If residential, is it: `pSingle 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 ❑ 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/badQiow preventer, must list licensed plumI5 r If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Oty of Ft Collins license 0
Electrician Plumber Mechanical Roofer Other
I hereby admowledge 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 (mow that a
permit is not valid until it has been paid and issued.
Print Name: K!�6ySignature -Q-�N9 Data
R6VWW date 2*M1 r