HomeMy WebLinkAbout1917 S Shields St - Applications/Furnace - 01/31/2019ltyof
Ct115
Planning, Development ag Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER -THE -HUNTER PERMITS ONLY
This application Is to be used to apply for the following parmNs only (check all that apply). 0 Air Conditioning
O Demolition (interior non-structural) 0 Electrical Alteration (not service change) 0 Gas Lighter 0 Gas Log
O Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement 0 Roofing 0 Sewer Line 0 Photo-vollalc
O Ventilation 0 Water Heater 0 Water Line 0 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 # 13 1 q Q VI (es
For d&erue only
Date /—,z5 / — / /
lab SRO Addros_ a rhwa/redI
Vahm of Construction (labor, �_ ale, Ixofit)
-5
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Property QWner Name
Address
City/Slate ZIP `' Phone
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- 9- -7s
Applicant Name
Address
Cfty/State Zip phone
Contractor
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Address
aty/State Zip Phone
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Contractor City of Ft Collins Sales Tax #
saestg�unrrrun�derisrepudradbyaNmrrtrarrws
Are you paying taxes here or by report? )If Here 13 Report
Are you paying with your trust account? 0 Yes 0 No
Is this a residential or commercial protect? Residential 0 Commercial
If residential, Is It: 0 rgle Family Detadred 0 Condo/bownhome (single family attached) E3 Duplex
'�Y (apartment) 0 Garage
If cammerdal, is It: Bank O Bar 13 Church 0 Hotel/Motel O Medical office 0 Office 0 Retail
13 Restaurant 0 Other (explain)
Is this building 50 years of Moor more? D Yes D No Ifyes, yvu may need to canbat Hkxortc R e-ewton
If this is for a denwiltion permit, what year was the building constructed?
Ifpolor to 1975, you w!P/ need an as bestos a ewneirt to -wbn%t midi d& apio imMon.
Description of work
"If lawn sprinlder/baddlow preventer, must list licensed plumber. If first-time AIC, must list licensed electrician.
Subcorri,actors. I& the company naim or 0?y ofRCoffins/kaaare 0
Plumber Medwnloi Roofer. Other
I hereby admowledge 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.
ApplieaM:
Print man
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