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HomeMy WebLinkAbout3821 Sky Gazer Ln - Applications/Furnace - 01/21/2019Clty6f Planning, Development, & Transportation Services ,Fort Collins Community Development & Neighborhood Services m 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 bleating Unit ❑ Lawn Sprinkler ❑ Mobile Home replac ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pe manufacturer). Complete all applicable inf yz ation onthe application. lApplication # I7O� For office use only ement ❑ Rooting U Sewer Line tJ rnoto-voltaic llet Stove (must be EPA certified, provide make, model and Incomplete applications will not be accepted. ! Date �1 23ob Site Address (required) Value of Construction (labor, ma rials, profit) Property Owne4 Name Address City/State Zip Phone © Applicant NarWe J Address City/State Zip Phone SMP NeC: TVIC- N400 �,l sas cr,463iti-gctgo Contractor Addressp� City/State Zip Phone __TM 1 F1fc1 T., Li417Ulv,,vvci(on 9)f. # (D'2 ori6,.lJ,`Hy (G fJi:535 C5 `) 31`f'S„94(6 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ELReport Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes Z Wo 5-a3io Is this a residential or commercial project? dResidagntial ❑ Commercial If residential, is it: ❑ Single Family Detached IV 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 may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? Description of work !i TQV 4 0 *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Ust the company name or City oFR Collins license # Electrician Plumber Mechanical - U-1, 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: Print Name: -Ye el-41 C�b�O Signature Date Revision date 2IW2017 `� of