HomeMy WebLinkAbout3908 Rock Creek Dr - Applications/Furnace - 12/22/2017FortCollins Planning, Development, & Transportation Services
Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main 970 416 2740 Fox 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 Conc
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas L<
0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -volt>
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, n
manufacturer).
Complete all'applicablllee Information on the application. Incomplete applications will not be accepted.
Application #y I-JO C01 `J Date 1 a I aa' l 1-
For oft e use only
Job Site Address (required) Value of Copstruction (labor, materials, pn
Owner Name Address
Applicant Name Address City/State Zip
and
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 O Report
Sales tax mmberIs,epuwredbyalfmntractws. (�)l Are you paying with your trust account? ❑ Yes O No
J `�I(Jl�i
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: 0 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or morel ❑ Yes ■ No Ifyes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
• .. %igilfllf921 RAT . -
*If lawn sprinkler/backflow, preventer, must list licensed plumber. If first-time A/C, must list licensed electr
Subcontractor's: L& the company name or Oty of Ft Collins license 0
Electrician Plumber Mechanical H1309
Roofer 1. Other
i
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:
Print Name: Signature am pate