HomeMy WebLinkAbout1331 Patterson Pl - Applications/Furnace - 01/08/2018Jan 08 2018 07:07PM HP Fax 9706130826
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City of Planning, Development & Transportation Services
F0 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 fcheck 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 accepted.
Application # 1 1) y ,) D Date 119119
For ofcp use only
lob Site Address (required) Value of Construction (labor, materials, profit)
00
Property Owner Name Address dry/State Zip Phone
5
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
A. MytAnfid&
Contractor City of . Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
sWes taxnumbwIsrepuiredbyall coimact". Are you paying With your trust account? Yes ❑ No
Is this a residential or commercial project? aQ Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑liar ❑ 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 Me building mnstructed?
Description of work _ T11 nafe, 1,rn(1iQ.Vr1&V
q n90 ODl
*if lawn sprinkler/backflow preventer, must list licensed plumber. if first-time A/C, must list licensed electrician,
Subcontractors: List the company name or City of Ft Collins license 0
Electrician Plumber Mechanical 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 vaNd until it has been paid and Issued.
Applicant -
Print Name: Signatu trater,�
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