HomeMy WebLinkAbout2300 Cotswold Ct - Applications/Furnace - 02/09/2018City of Planning, Development, & Transportation Services
Fort 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 (check 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 # �� c)� « Date all Z($
For office use only
Job Site Address (requrred) Value of Construction (labor, materials, profit)
c2300 "wold + a10C-)
Property Owner Name Address City/State Zip Phone
5 H a ri' em I Q MVMe go501 Q-3q 3-CfOCI
Applicant Name Address IF City/State Zip Phone
. IN
Contractor Address City/State Zip Phone
No C', H V IC0I Ar S Nar `4-Colfcr.5 qv a 5 q70-507--7foZ
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? I1:4ere ❑ Report
Sales tax number is required by allcon&actors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? idResidential ❑ Commercial
If residential, is it .,Single 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? 4We09(jVci If yes, you may need to contact HrstoncPreservation
If this is for a demolition permit, what year was the building constructed?
Description of work r Rt, acrnaln'r Q
*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 #
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: �n�• C/
Print Name�Orv% &C►� VN Signat Date .2
Revision date 2/612017