HomeMy WebLinkAbout1028 S Taft Hill Rd - Applications/Furnace - 12/17/2018City of planning, Development, & Transportation Services
�Frt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.274D 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
Zemolition (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 ❑ 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 # P-A'%� IOZ`f
For office, use only
Date December 17, 2018
Job Site Address (required) Value of Construction (labor, materials, profit)
1028 Sctt6vTP f REZI RcL /=oet CaUiyy, CO 80521 $4069.00
Property Owner Name Address City/State Zip Phone
CrrnnerRevoca.ble/LwivuyTru,;t 1028 S Taft-HaLRd, Ft'CcVZ4m,, Co- 80521 970-482-0815
Applicant Name Address City/State Zipp Phone
OwC6b wuvEva.1k 101 S LLnk l_a.ne )=tco-, CO 80524 494-7632
Contractor Address City/State ZiPP Phone
AlletvSe,rvLcPi 101 S LLnk�Lanz Ft- Cc-, CO 80524 484-4841
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑1,iere ❑ Report
Sates tax number Is required by all contractors. Are you paying with your trust account? Yes ❑ No
10010
Is this a residential or commercial project? itResidential ❑ Commercial
If residential, is it: M Single Family Detached 0 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 mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Ranwve eX 3Yuuy(urnacen ur•rej inu.+v t3vnew rikefuow
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname or G-ty of Ft Collins license #
Electrician Pfumber 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. 1 " �/
Applicant: ChrvtuuvEvaw ( /f, 1 i C I� + 1 (l
Print Name: Signature , f `1 + ! ( :� { �` �,-� Date (. °�
Rawlan date 2WO17