HomeMy WebLinkAbout2831 Michener Dr - Applications/Furnace - 12/05/2016Planning, Development & Transportation
Fo t�Cottins 2Fort Collinsl, CC) 80524 Ave O. Box 580
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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) O 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 # (3)(o0 `7341 Date X, s /
For aft,ewea„b,
Sob Site Address (&qu/md)
Value of Construction (labor, materials, profit)
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Utz
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Property Owner Name Address
C ty/State Zip
Phone
ApplIcarit Name 0 Address
CIW/State Zip
Phone
Contractor Address
City/State Zip
Phone
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O .5
-.Z;W-
Contractor Cityof Collins Sales Tax #
Are you paying taxes here or by report? 18( Here
❑ Report
salesOx number is byavconrraam
Are you paying with your trust acoount? ❑ Yes
❑ No
Is this a residential or commercial project? Wesidential ❑ 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? O Yes O No If ym, you. may. need to contact - Historic Preservaton
If this is for a demolition permit, what year was the building constructed?
If prior to 1975 you wi// need an asbeskas assessment to submit with this app/uabon.
Description of work 2 '�/ig A
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of R Coin /khans+° JP
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 tD
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I Imow that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: "i i'.'r Signature Date -5"-/ .