HomeMy WebLinkAbout1557 Corydalis Ct - Applications/Furnace - 12/22/2017artGty�f Planning, Development, & Transportation Services �lEn
Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Mein 970A16 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
® 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
Application #
For once use only
Job Site Address (requ/red)
Property Qwner Name ,address
accepted
Date a I 33d 1-1
Value of (labor, materials, profit)
r—
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
P Phone
Fort Collins Heating & Air 208 Commerce Dr #4 Fort Collins, CO 80524 970 484 4552
Contractor City r ul Collins
yall Sales Tax #
Salestax nwmberesAre you paying taxes here or by report? ❑ Here N Report
epuiredbyal/con&NI' ;. �))qN 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 commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this budding 50 years of age or more? ❑ Yes ■ No If yes, you may need to contact H&Wc preservation
If this is for a demolition permit, what year was the building constructed? _
Description of work
*If lawn sprinkler/backf ow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors; L/sY the company name or C11Y of Ft Collins l/cense #
Electrioan Plumber. Medianical 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: I II IC r,
Print Name! I ` j V Signature
Reviaon date 2M17
Date _14T