HomeMy WebLinkAbout3255 Kingfisher Ct - Applications/Furnace - 12/10/2019Cif of Planning, Development & Transportation
F6�+y �/�``'' 1. 281 N. College Ave P.O. Box 580
rt Collins 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),
J'Air Conditioning ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log4�kleating 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 #
For office use only
Date
Sob Site Address (required)
Value of Construction (labor, materials, profit)
• 'Sh FG 60 &252-5
4 &- s &W —
Property Own ame Address
Dcw6 01d Cavr6W&W
City/State Zip Phone 467
f
27
Applicant Name Address
City/State Zip Phone 970
Pr or Plitrl bi and �-,tf7
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Contractor AcYdress
City/State Zip Phone (a'0
P►-
rL' rL
67 LC-Jq arM n I ! i ll
Contractor City of Ft. itudins Sales Tax #
Are you paying taxes here or by report? XHere ❑ Report
Sales tax number Is requIred by a# contactors.
Are you paying with your trust account? %.Yes ❑ No
Is this a residential or commercial project? I�Residential ❑ commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
IT 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 Ifyes, you may need to contact Hlstoric 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 orttyCity of
Collins license #
a
Electrician Plumber 1"�lf Ci(/O ! Mechanical-42T(&!? H- 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:
Name: --&H-h K1. jx Signature � � Date I I P_