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HomeMy WebLinkAbout2154 Orchard Pl - Applications/Furnace - 11/29/2018 (5)i Citv of Planning, Development, & Transportation Services FOrt Collins Community Development & Neighborhood Services 281 North College Avenue Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134 ' J 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 *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 Information on the application. Incomplete applications willl not be accepted. Application # - 2� � (�y�C7 Date \ \ zA For office use only Job Site Address (r uired) Value of Construction (labor, materials, profit) CIS L © (�.�,kk-P 06 Property Owner Name Address City/State Zip Phone So { lM Applicant Name Address City/State Zip Phone NO Aj�a r 1 P ffQx o ZOVC_ 1 Nn Co, �v q90-,97-os7 Contractor Address City/State Zip Phone 72/E Si'A>1er 6XO-r s+1 c . B4 it 1301( Loue l� as So s��y `? #b Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report Sales tax number& required by allconbacto7s Are you paying with your trust account? ❑ Yes 9No Is this a residential or commercial project? Residential ❑ Commercial If residential, is it: ❑ Single Family Detac ed ❑ 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 Historic Preservation If this is for a demolition permit, what year was the building constructed? Description of work NI/A-c- , U a q4e *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: list the company name or City 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. Print Name:_ i4� X ' / ff sl r/ Signature Date ` '"\&k M ' (� Revision date 2/612017