HomeMy WebLinkAbout208 Mae St - Applications/Furnace - 01/09/2019..F-'ILY01 Planning, 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
A 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 #_ ic Date
For o free use only
Sob Site Address (required) Value l0 nstruction (labor, materials, profit)
Property Owner Name Address City/State 6 Zip 2Phone
Applicant Name Address City/State Zip - Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor Address City/State Zip Phone
Fort Collins Heatin & Air 208 Commerce Dr. #4 Fort Collins, CO 60524 970.484.4552
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here AReport
Sales tax number is required by allcantractors. n 1� Are you paying with your trust account? Ai Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: XSingle 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 SO years of age or more? ❑ Yes ❑ No if yes, you may need to contact Historic preservab'on
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backftow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City ofRCollins license ,#
Electridan Plumber Mechanical H1309
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: �n
Print Name: C i MC Y Signature Date
Revision dete maoV