HomeMy WebLinkAbout234 N Mckinley Ave - Applications/Furnace - 09/25/2018,FCity of pianning, Development, & Transportation Services
ort 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
ZHeating 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 # b1(W b W 0
For office use only
Date Sep mber 25, 2018
Job Site Address (requlrao Value of Construction (labor, materials, profit)
234 N McXtnleyAves FortCoULrw,, CO 80521 $4749.00
Property Owner Name Address City/State Zip Phone
Mega4VGrgRt3v 234 N McKinley Ave, FortCoUiru; CO 80521 303-909-0444
Applicant Name Address City/State Zipp Phone
ckwLsttnw£va.wy 101 S Ltnk�Larue )=tcc; CO 805Z4 494-7632
Contractor Address aty/State Zipp Phone
AUlewServC,c& 101 S L%rik.Lan& Ft co-, CO 805Z4 484-4841
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ jlere ❑ Report
Sulestax number IsivgWr dbyaNcarrtadom Are you paying with your trust acoount? IfYes ❑ No
10010
Is this a residential or g/mmerdal project? 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 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact HistoricPrese/vatton
if this Is for a demolition permit, what year was the building constructed?
Description of work Remaver ex4tCr*f kma t& replace,wXly idke, new furw
*If lawn sprinkler/bacidlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or aty of Ft Collins license #
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. /n�
Applicant: ChrultLna £vavi� � V L f c,Q r e/1111 & 1n i/I Q ql�5 119
Print Name: Signature tV/I1 �V l( l.(}J (X (LJl /lr(,y 1.,0 Date
Rew� m� s aaon