HomeMy WebLinkAbout400 Peterson St - Applications/Furnace - 01/10/2018From: 01/10/2018 09:11 #860 P.001/001
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FCity of Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
.r 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 O Gas Log
l[4%eating 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 onntthe
application. Incomplete applications will not be accepted.
Application # 1)1 �00 O Date
For o/Tice use only
)ob Site Address (required) Value of Construction (labor, materials, profit)
90
Property Owner Name Address City/State Zip Phone
g -
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you.paying taxes here or by report? 03iere ❑ Report
Sales tar number urequired byall contractors. Are you paying with your trust account? des ❑ No
3Se°ns
Is this a residential or ommercial project? esidential ❑ Commercial
If residential, is it: Ingle 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 O 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�R� o i IYnt o_
*If lawn sprinkler/back iow 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 #
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 valid until it has been paid and Issued.
Applicant: s
Print `� . Print Name: C\'�c�s! G.il��l1_M Signature �e �� �, S1�* � Date C1
Revision date 21g/2017