HomeMy WebLinkAbout718 Marigold Ln - Applications/Furnace - 02/09/2018Feb 09 2018 06:54PM HP Fax 9706130826
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Planning.,
Fort Collins g., Deve10pmen4 & Transportation Services
Community Development & Neighborhood Services
281 North College
Fort Collins, CO 80524e 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 0 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application #_ill'
Foruse only
Incomplete applications will not be accepted.
Date n?g(1�_
lob Site Address (required) Value of Construction (labor, materials, profit
'
Property OwneriJame 3�GGo ��
Address City/State
Zip Phone
Applicant Name Add City/State UOP Zi a
P Phonn e
Contractor Address City/State Zip Phone
Contractor City of. Collins Sates Tax # Are you paying taxes here or by report? Here ❑ Report
sarestaxnwnaertsrere graedayadconaaca„� Are you paying with your trust account? Here
O No
Is this a residential or commercial project? 4(Residential ❑ 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 so years of age or more? ❑ yes 'O No If yes, )Vu may need to cnrrtact NisYnric preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backFlowr preventer, must list licensed plumber. If first-time A/C, must list licensed eiectdCian,
Subcontractors: L& the company name or Crty of Ft Collins license #
Elect^clan 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.
go 1 I I. 3 iil�l»i I
Date
R0i810n date 26f2D17