HomeMy WebLinkAbout826 W Myrtle St - Applications/Furnace - 12/27/2017Planning, Development & Transportation
.I t L CG r _y 281 N. College Ave P.O. Box 580
�,6�t Qolfins Fort Collins, CO80524
Phone 970-416-2740 Fax 224-6134
OU TER PERMITS ONLY
This application is to ba used to apply for the following permits only (check all that apply). D Air Conditioning
❑ D holition (interior non=structural)1 D E(ectricai Alteration (not service change) D Gas Lighter ❑Gas Log
eating Una ❑ Lawn Sprinkler a Mobile Home iepiacement Ll Roofing ❑ Sewer line ❑ Photo -voltaic
❑ VenBlation ❑ Water He1�11ater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, modal and
manufacturer)
Complete all applicable info a on n the pl9catlon. Incomplete applications will not be accepted
Application #
Date
For olffc'e use only
Sob Site Address ilraqulred)
property Owner Name Address
I li _ __ _ C _ is.....,
Applicant Name_, _ Address
T U 1b, i
Contractor Address
Colfractor Gty of Ft. Collins Sales -Tax`#
:al�stih numb�vtsraqurreiitiy'all mribac&V=
Is this, a residential or commercial mercial project? V.P-, dent
iF residential, is it: r Single Family Detachd(d 0 Cor
❑ Multifamily, (apartment) ❑ Gar
If commercial, is it: ❑ Bank ❑ Bar ❑ Church 0 Hot
Restaurant ❑Other (explain;
Is this building So years o� age or more? Yes N
If this is for a deinolition permit, what year viaithe bul
1r,orior to 1975, you will need an asbesins assessment to
Description of work
value of Construction (tailor, macenais, p:unc)
5 24_ $ L4 937.^
Gty/State Zip _ _ Phone
Are you paying taxes here or by report? ❑ Here
Are you paying with your trust account? JtY6S ❑
❑ commercial
nwnhome (single family attached) ❑ Duplex
❑ Medical office ❑ Office D Retall
ye�y may need to contact Hjs o cPreservatton
constructed?
It with tfiis application.
,,if lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must Rst,licensed electrician.
Subcontractors: Lrsttha cvmpanyname"orC3tyofftColl/ns/kL*rsse #
Other
Elatnoan_ —
Mechanloi Raofet
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 taws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
I Applicant;I 1 an 1 v^ ltil' .
Print Name., N - Signature- Ls