HomeMy WebLinkAbout2727 Canby Way - Applications/Furnace - 12/08/2016Plannidg, Development & Transportation
1 i:1 yYi 281 N. College Ave P.O. Box 530
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
PERMS ONVY
This application is to be used to apply forthe following permits only (check all that apply). ❑ Air Conditioning
U Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
C�aating unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
Cl Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA ceitified, provide make, model and
rnanufacturer).
ColiIplete all applicableinformationon the application. Incomplete applications will not be accepted.
Application # y J� Date. IJIY�� lr
For afce use only
lob Site Address (required) Value ofConstruction (labor, materials, profit)
--c c Y - 55 -S! S
Propperty Owner Name
/ {PAddress City/State Zip Phone
G` q Z 7
Applicant Name. Address City/State Zip Phone
u,r
Contractor Address City/State Zip Phone i
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ' r .Report
na%numbarisraquiredbyall conlractois Are you paying with your trust account? 'e_Yes ❑ No
Is this a residential or cocnfnerdaI project? 0'ResidenGal ❑ Commercial if residential, is it: EI Single Family Detached ❑ Condo/townhome (single family attached) 0 Duplex
❑ Multifamily (apartment) ❑ Garage
Ir commercial, is it: ❑ Bank ❑ Bar El Church ❑ Hotel/Motel El Medical office ❑ Office❑Retail
El Restaurant ❑Other (explain)
Is this building bD years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to mntactHistoncPreseruation
if this is for a demolition permit, what year was the building constructed?
ff prior to 1975, you will need an asbestos assessment to submit with this appiicauon. —
Description of wort: _
"`Ir lawn spii klei/backilow preventer, must list licensed plumber. If first-time A/C, --must licensed electrician.
Subcontractors: List the company name or City of Ft Collins license
Elecfriciar.__ Plumber Mechanical Roofer — _ Other =
f 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 knoly that a
permii: is not valid until it has been paid and issued.
y r
Applicant: G 4 )
Print Nam _ Signature ate�_—
..4