HomeMy WebLinkAbout1209 Town Center Dr - Applications/Furnace - 09/16/2019 (2)City of
F,`rt Collins
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply).
OK Air Conditioning ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log X Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ 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 #b1g100gqb ejglo q7 Date GIaI(G
For office use only In (O Q q X nig I d g 9 L
Job Site Address (required)
Value of Construction (labor, materials, profit)
00
Property Owner Name Address
City/State Zip
Phone
Et (0111p SOM
- c499-S639
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Ofill
+vl l S38
S
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
AYes ❑ No
Is this a residential or commercial project? E� Residential ❑ Commercial
If residential, is it: K Single 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 (expl in)
Is this building 50 years of age or more? ❑ Yes K 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
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber
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.
Print Name:
.,.111I .I ANNI 11 u I ...
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