HomeMy WebLinkAbout1805 S Shields St - Applications/Furnace - 11/29/2016 (3)CY Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 22"1-M
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing' ❑ Sewer Line ❑ Photo -voltaic
❑ 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 # B �acn Date _/� y' J �r
For ofte use only
lob Site Address (repulred)
Value of Construction (labor, materials, profit)
os- � Stu ds J I
IF
030 . aef
operty Owner Name Address
City/State Zip Phone
1 _;�
F
— -77.5zl
plicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
Contractor. City of Ff Collins Sales Tax #
Are you paying taxes here or by report? Here ❑ Report
Sales number isrepuiredbyallcvnbacmm
�
Are you paying with your trust account? ❑ Yes ❑ No
Is this a;residential or commercial project? Pkesidential ❑ Commercial
If residential, is it: ❑ Single Family Detach6d 13 Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ! ❑ Garage
If commercial, is it: Bank ❑ Bar ❑ Church 0, Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or rrwre? 13 Yes : b No If yes, you may need to contact Historic Presermbon
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you MY need an asbestos assessment to submit with this application.
Description of work.
*If lawn sprinkler/badcfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or CRY of;Ft Collins bcense �
Electrician Plumber Mkhanlcal Roofer Other
I
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.;ordiriances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.'
Applicant: 1 � '
Print Name , !� Signature paw�� �t!p
S/s" /y'-9-3 f2. 3S -ems = zlF /cal,