HomeMy WebLinkAbout1917 S Shields St - Applications/Furnace - 02/05/2018ao /-�/Z/
F-6m C011ins
of
Planning, Development & Transportation
281 N. College Ave P.O Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 #
For of a use only
Date
Job Site Address (required)
- Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip Phone
S70_5 f 4f,75
Applicant Name Address
Gty/State Zip Phone
Contractor Address
City/State Zip Phone
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F05.5 7n% --z;W-
Contractor City of F . Collins Sales Tax #
Are you paying taxes here or by report? X Here ❑ Report
sales��,rrnumber isrwiaredbyall conbactom
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? MResidenbal ❑ 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? ❑ Yes ❑ No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the budding constructed?
Ifpnor to 1975, you ran// need an asbestos assessment to submit with this app/rcabon.
Description of work
*If lawn sprinider/baddlow preventer, must list licensed plumber If first-time A/C, must list licensed electrician
Subcontractors: Lust the company name or City of R Co//ms license #
Electnaan Plumber Medianical 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 budding construction I know that a
permit is not valid until it has been paid and issued.
Applicant: Ip
Print Nam Signature pate
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