HomeMy WebLinkAbout3113 Cumberland Ct - Applications/Furnace - 10/01/2018City of Planning, Development, & Transportation Services
,,Foil$ 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). kpkir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 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 infoBnabon on the pplicattion. Incomplete applications will not be accepted.
Application #% SISM4ate V2 \ k\\'
r office use only
lob Site Address (required) Value of Construction (labor, materials rofit
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? W3iere ❑ Report
sales tax number lsrequiredbyall conbactom Are you paying with your trust account? VPYes ❑ No
3W205
Is this a residential or commercial project? (Ciesidential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
O Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant O Other (explain)
Is this building 50 years of age or more? ❑ Yes O No Yy s, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the buildi constructed?
Description of wor
*If lawn sprinkler/backnow preventer, must list licensed plu bur. If first-time A/C, must list licensed electrician.
Subcontracbors: List Oe company name or Oty of Ft Collins license x
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:\\
Print Name:KN-SU G.\ttzre. Signature cz�L VASj v'a,, Date
ROASim date 2r/2017
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