HomeMy WebLinkAbout3213 Killdeer Dr - Applications/Furnace - 12/12/2016Fort 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
t(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 # C/ 1bD4-'F 69
For ofte use only
Date 12/12/16
Sob site Address (required)
Value of Construction (labor, materials, profit)
3213 Killdeer Drive Fort Collins, CO
$3380.00
Property Owner Name Address
City/State Zip
Phone
Susan Labadie 3213 Killdeer Drive Fort Collins 80626970-223-546
Applicant Name Address
City/State Zip
Phone
Busse I G, 4 ki n I 140 C� -
kh Gre e.l e ,I.Co scb 31
3`2
Contractor Address
City/State Zip
Phone
A(6A6tWe. R,1A
1141 SAVOE - --
213 1?53
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? 3R Here ❑ Report
Sales tax number is required by all conbadnrs.
Are you paying with your trust account?
❑ Yes P1 No
t-I(; q -I -1
Is this a residential or c mmercial project? 0 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 WNo Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pr1or to 1975, you will need an asbestos assessment to submit with this application.
Description of work Replace 80,000 BTU Furnace
*If lawn sprinkier/badcflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins 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.
Applicant: //�� / ��
Print Name: rCi f4 / (-JI T/i i Signature
Date 12/12/16