HomeMy WebLinkAbout5205 Mail Creek Ln - Applications/Furnace - 12/20/2016From:
12/20/2016 08:10 0433 P.002/002
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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
gMeating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation %J�lMater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable
jjinformation on the application. Incomplete applications will not be accepted.
Application # � Ij or�4 S_ 7 Date 1aJQD) I b
For office use only , eX I Id n1 )
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
t
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Appiicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? OrHere
*Report
Sales tax number ismgrdredbyall contractors.
Are you paying with your trust account? KYes
Iq No
Is this a residential or commercial project?
If residential, is it: P5ingle Family Detached
Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Church
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
Yprior to 1975, you w111 need an asbestos assessment to submit with this application.
Description of
Residential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
"If lawn sprinkler/backflow 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 g.
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:(��tn��_ G��h� Signature. 1 6 ■L rr�_ Date