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HomeMy WebLinkAbout2718 Garrett Dr - Applications/Furnace - 02/16/2018FCity of Planning, Development, & Transportation Services it 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 # �0' o� Date 2I 1 For office use only Job Site Address (required) Value of Construction (labor, materials, profs 6" 1 6 Property Owner Name Address City/State Zip `/o0 as p�_ r. F f' - C 'n C U. `l Applicant Name Address City/State Zip Phone Contractor ress City/State Zip Phone qq z - 1' 3 Contractor City of Ft. Collins Safes x # Are you paying taxes here or by report? .❑ Here ®Report Sales tax number is required by a#contactors. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or commercial project? 19 Residential ❑ Commercial If residential, is it: KFSingle 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 ❑ 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 P *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 y25 13 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, (� Print Name: i QL S' ature � to —'t/ G r Revision date 216/2017 �� U 63cf 11 •.