HomeMy WebLinkAbout1708 Pecan St - Applications/Furnace - 12/06/2016From
12/06/2016 09:22 #417 P.001/001
Fort 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
'01' feating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line . ❑ Photo -voltaic
❑ Ventilation O 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 #� T
For ogce use only
Date owl
lob Site Addr,.es�s(mq�uined).
Value of Construction (labor, materials, profit)
YY�
st
Property Owner Name Address
City/State Zip Phone
Applicant ame Address
City/State Tip Phone
Contractor Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? WHere *Report
Sales tax number is mquireyby all conbat-tas.
Are you paying with your trust account? XYes Ci No
Is this a residential or commercial project? Q. sidential O Commercial
If residential; is it: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
D Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O No If yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this applicat ron.
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 i7ty of Ft Collins license #
Electrician Plumber Mechanical Roofer
6G417M
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: [�. /� ti
Print Name: ` `y1CD\Q - l7'kQ_\%TVy% Signature., u .S e Date I