HomeMy WebLinkAbout1007 Mullein Dr - Applications/Furnace - 12/27/2016From
12/27/2016 06:19 #f444 P.001/001
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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
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.
Application # b i U)V/o
For office use only
Incomplete applications will not be accepted.
Date _ l2 —t) � �
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
Kb
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s
Applicant 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? NrHere
.Report
Sales tax number is required byall contractors .
Are you paying with your.�rust account? XYes
Cl No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: D Single Family Detached ❑ Condo/townhome (single family attached) D Duplex
D Multifamily (apartment) ❑ Garage
If commercial, is it: D Bank D Bar D Church ❑ Hotel/Motel ❑ Medical office ❑ office D Retail
D Restaurant D Other'(explain)
Is this building So 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?
If pr1or 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 City of Ft Collins license #
Electrician Plumber Mechanical Roofer
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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: \ \\C 4 - lT\Q tin SignatureDate �o