HomeMy WebLinkAbout2407 Ute Ct - Applications/Furnace - 02/25/20196'3- 75'
Plennine. Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, 00 80524
Phone 970-416-2740 Fax 224-6134
OVER -TIME -COUNTER PERMITS ONLY
This application Is to be used to apply for the following parmits only (check all that apply). O Air Conditioning
O Demolition (interior non-structural) O Electrical Alteration (not service change) 13 Gas Lighter 0 Gas Log
O Heating Unit O Lawn Sprinkler O Mobile Hone replacement O Roofing 0 Sewer Line O Photo -voltaic
D Ventilation O Water Heater O Water Line 13 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacduer).
Complete all applicable Informationonthe application. Incomplete applications will not be accepted.
App�icatiort # U g D 1 V Date
For ofilce rage only
20b Ste Addr= (mquhsdl
Valm of Construction (labor, materials, Profit) --
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Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
Clty/State Zip Phone
Contractor Address
city/State Zip Phone
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Cw*actor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? X Here O Report
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Are you paying with your trot account? O Yes O No
Is this a residential or commercial project? P Residential O Commercial
If residential, is it: IlSingle Family Detached O Condo/townhome (single famiy attached) O Duplex
(apartment) O Garage
If commercial, is It: E3 Bank 0 Bar 0 Church 0 Hotel/Motel O Medical office O Office E3 Retail
i] Restaurant O Other (explain)
Is this Wilding 50 years of age or more? Ems ®No Ifyes, you may need to contact H&ork Prewwhon
If this is for a demoBtion pmml% what year was the building constructed?
Ifprior to 1975, XV oil/need an asbestes aZW3 next to subunit WIM th/s apl*abvn.
Description of work
*If lawn sprinkier/baddlow prevenber, must fist licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Lit the company name orOtyofRCNInsftwsre0
Wumber Medwrool Roarer Other
I hereby admowledge that I have read this application and state that the above information is compkte and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws.reguiating building construction. I know teat a
permit is not valid until It has been paid and issued.
Applicant: /
Print Name Signature ` Date f