HomeMy WebLinkAbout1032 Cunningham Dr - Applications/Furnace - 02/07/2018From*
02/08/2018 08:41 - #903 P 001/001
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City of Planning, Development, & Transportation Services
F�0 Colons Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main 970A16 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
t*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 Inn/formation on the application. Incomplete applications will not be accepted.
Application # R1 vW�2 O�_ Date -I\:]
ForoAicce um only
Job Site Address (requked) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip hone
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ZA
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft Co ins Sales Tax # Are you paying taxes here or by report? $Oiere ❑ Report
Sales raxmrmbe,csre4ulredbya0avnbactas Are you paying with your trust amount? YPYes ❑ No
Is this a residential or commensal project? P❑ esidential ❑ Commercial
If residential, is it: VSingle Family Detach 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? D Yes ❑ No ffyes, you may need to contW Historic Prawn thin
If this is for a demolition permit, what year was the building constructed?
Description of wo
*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L &the cwwny name or C7ry of Cb/#ns /!tense 0
Bectndan Plumber Mechankal 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.
Appik ent:
Print Name: SN {u ' G& 0�re. Signature CNz_ y ��1� paw
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