HomeMy WebLinkAbout3508 Coneflower Dr - Applications/Furnace - 02/05/2020Feb 04 2020 05:30PM Swan 9706130826
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FF-ort 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).
JW Air Conditioning [I Electrical Alteration ❑ Gas Lighter ❑ Gas LogA 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 # 69m I I Date � / �S J QCD5Lc7
For ofte use only
lob Site Address (requlred)
Value of Construction labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
Contractor Address
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City/State Zip Phone
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Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ere ❑ Report
Sales tax number Ismqubedbyall canlradms, Are you paying with your trust account? W Yes ❑ No
Is this a residential or commercial project? 34 Residential ❑ Commercial
If residential, is it: ❑ 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 (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact H/stoNcft5ermdon
If this is for a demolition permit, what year was the building constructed?
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*If lawn sprinkler/back0ow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors, List the mmpanynameorCity offtCollins 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.
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