HomeMy WebLinkAbout2412 Poplar Dr - Applications/Furnace - 01/08/2018From
01/08/2018 06:33 #856 P.001/001
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Planning, Development, & Transportation Services
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 (check all that apply). r Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) Q Gas Lighter 0 Gas Log
'bleating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
Q Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the pplication. Incomplete applications will not be accepted.
Application # �2 Date.
For ofTiae use only
lob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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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? V3iere Q Report
Sa/estax number isrequired byall mnbadors Are you paying with your trust account? des ❑ No
3��ns
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Is this a residential or commercial project? esidential ❑ Commercial
If residential, is it: ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
13 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 cvntac7 Historic Preservation
If this is for a demolition permit, what year was the buildi g constructed?
Description of woe
*If lawn sprinkler/backflow preventer, must list licensed plu ber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or G'ty 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
:��t ��I• - �� �`M Signature ��,�,�j Date
Print Name--A'y- 9
Revisaw date 1.WM 7