HomeMy WebLinkAbout2702 Rawahs Way - Applications/Furnace - 12/08/2016Planning, Development & Transportation
.. 281 N. College Ave P.O. Box 580
� Mn s Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
m E=COUNTER PERMITS ONVY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
�nating Unit 0 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 # S I 0\ 7q J Date
Fir nffice use only
ob Site Address (required) Valve of Construction (labor, materials, profit)
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Property Owner Name �7Address City/State Zip Phone
Applicant Nam Address �, City/State Zip Phone
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Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here • I!.Report
_;,a> ra% numberleraquiredbyagcontractors. Are you paying with your trust account? 7-yes ❑ No
10010
Is this a residential or coJ�mercial project? Residential ❑ Commercial
IF residential, is it: G( Single Family Detached ❑ Condo/townhome (single family attached) ❑Duplex
❑ Multifamily (apartment) ❑ Garage
Ir commercial, is it: ❑ Bank ❑ Bar Cl Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, }'ou may need to contact HistoricPreservab'on
If this is for a demolition permit, what year was the building constructed?
rf piia- to 1975, you will need an asbestos assessment to submit with this application.
Description of work _ R .V_--
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If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
S u bco ntra cto rs: List the company name or City of Ft Collins license ,V
Eleccrici.�n___ 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 kno>,v that a
permit is not valid until it has been paid and issued.
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Print Nam Signature ate_ __ ��_-.._--
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