HomeMy WebLinkAbout761 Marigold Ln - Applications/Furnace - 03/17/2020Mar 17 2020 10:09AM Swan 9706130826
page 5
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVERmTHEiCOUNTER PERMITS ONLY
This application is to be used to apply for the following permits o ly check all that apply).
❑ Air Conditioning ❑ Electric al Alteration ❑ Gas Lighter ❑Gas LogiWeating 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 #
Fvrofte use only
Date
Job Site Address (regained)
1 1 Q` L 1-�
Value of Construction (labor, materials, profit)
-3 c� I ._
Property Owner Name Address
chty" k itlWaU UCe Itpi iY10;1'1
City/State Zip ho .
o 1C"
i�S 2 Z
Cell q
Applicant Name Address
SS\� ► O-0-10 Sqa W-,U( 4 h 0
City/State Zi m
�aJeO)dc-6 `;.
Contractor Address
City/State Zip Phone
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? Vere ❑ Report
-%festaxnumber[sr qukvdbya#mn&acft,
Are you paying with your trust account? . Yes ❑ No
Is this a residential or commercial project? 4&esidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Cando/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 0 No If yea, you mayneed to contact Hkmor cc Premrvadon
If this is for a demolition permit, what year was the building constructed?
Description
*If lawn sprinkler/bacldlow prevenber, must list licensed plumber. If first-time A/C, must list licensed electritdan.
Subcontractors: L&t ft company name oraty ofR coffins/1C&M #
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 blow that a
permit Is not valid until it has been paid and issued.
Applicant: '7�
Print Name: u ��gnatu 1 Date