HomeMy WebLinkAbout2338 Chandler St - Applications/Furnace - 12/04/2018�FCityof Planning, Development, & Transportation Services
6rt 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
❑ emolition (interior non-structural) 17 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
L7 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 #,
�31�1 a5�8
Forotiice use only
Date `E>ecembe - 4, 2018
Job Site Address (required) Value of Construction (labor, materials, profit)
2338 Cha.ncilerStyeet, Foi tCoi CYW, CO 80528 $5662.00
Property Owner Name Address City/State Zip Phone
Robert/MayVe#� 2338 ChartdlerSt FtCaLUt y, Co- 80528 970-620.1582
Applicant Name Address Clty/State Zlpp Phone
Ckw6Wu a,Evaywy 101 S L%nk Lane Ft Ca; CO 805Z4 494-7632
Contractor Address Clty/State Zipp Phone
AUeivServCc& 1015 LLnk�Laalel Ft Cc-, CO 80524 484-4841
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑yere ❑ Report
Sales tax number tsrequired byallconrradom Are you paying with your trust account? V Yes ❑ No
10010
Is this a residential or Vmmerclal project? Residential ❑ Commercial
If residential, is it: M Single Family Detached 0 Condo/townhome (single family attached) 17 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office M Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact HlstodcPreservation
If this is for a demolition permit, what year was the building constructed?
Description of work Renavicexuw {y{u»tace caul replace wuh new GY�(urwu�
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Lfstthe company name orCity ofFtCollins license#
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read thls 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: Chv%stGvlwEva ws r �l} � d= Evarl�!Date
Print Name; Signature l��u
Rovis:on dale 718017