HomeMy WebLinkAbout4006 Big Dipper Dr - Applications/Furnace - 01/07/2020Citry Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fo1 t 'ollinS 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).
❑ Air Conditioning ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ❑ 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 # �� n(1{1 1�41�
For office use only v
Date 12/4/19
q
Job Site Address (required)
Value of Construction (labor, materials, profit)
4006 Big Dipper Drive
.43017 3 - @0
Property Owner Name Address
City/State Zip
Phone
Eric Hutchison 4006 Big Dipper Drive, Fort Collins, CO 80528 USA
(970) 495-0455
Applicant Name Address
City/State Zip
Phone
[
MAqWNZ C 4600 Innovation Dr. Suite 102 FortCollins CO 80525
970-399-9940
Contractor Address
City/State Zip
Phone
Benjamin Franklin Plumbing 4600 Innovation Dr. Suite
102 Fort Collins, CO 80525
970-399-9940
Contractor City of Ft. Collins Sales Tax # =
Are you paging taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by allconbactws
Are laying with your trust account?
❑ Yes ❑ No
52310
Is this a residential or
If residential, is it:
13
If commercial, is it: ❑
project?
❑ Commercial
Single Family Detached ❑ Condo/tow=13Medical
single family attached)
Multifamily (apartment) ❑ Garage
Bank ❑ Bar ❑ Church ❑ Hotel/ office ❑ Office
❑ Other (explai
Is this building 50 years of age or more? ❑ Yes No lfyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
❑ Duplex
❑ Retail
Restaurant
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.
Applicant -
Print
f �/
Print Name: ffty(lW�li � Signature
Date
12/4/19