HomeMy WebLinkAbout1244 Dewey Dr - Applications/Furnace - 12/22/2016From
12/22/2016 06:10 #436 P.001/001
Iq S`�1 l
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
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 # 1(Oo�w5 Date \a to
For ofte use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
bD
Property Owner Name Address
City/State Zip
Phone
y
-
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Ya Here
*Report
Sales tax number is required by all contractors.
Are you paying with your trust account? X Yes
El No
Is this a residential or commercial project? 4b-Aesidential ❑ Commercial
If residential, is it: iE�Single Family Detached ElCondo/townhome (single family attached) ❑ Duplex
1❑ 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? O Yes ❑ 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 application.
Description of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Cty of R Collins license #
Electrician
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: ` `� �QNVVY%. Signature Date �_ Date