HomeMy WebLinkAbout1917 S Shields St - Applications/Furnace - 12/29/201674,7U�
FO tofCO has
Planning, Development g Traruportation
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). 0 Air Conditioning
0 Demolition (interior non-structurel) 0 Electrical Alteration (not service change) 0 Gas Lighter 0 Gas Log
O Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement 0 Roofing 0 Sewer Line 0 Photo -voltaic
0 Ventilation O Water Heater ❑ Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable I�Mormetion Jon the application. Incomplete applications will not be accepted.
Application # 1 ✓ I � � 1 Date
For oil use only
Sob Siite Address (repuhed)
value of Construction (labor, materials, profit)
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D av
Property Owner Name Address
C ty/State ZJp Phone
17 -s s� e m-
Applicant Name Address
Clty/State Zip Phone
Contractor Address
Gty/State Zip Phone
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BO S -IOU-
Contractor City of FE Collins Sales Tax
t Are you paying taxes here or by report? )8f Here 0 Report
Saes tar nurMffIF!Mcoedbyai7M&aavm
Are you paying with your bW account? 0 Yes 0 No
Is this a residential or commercial project? . P.Residential 0 Commercial
If residential, is it: Single Family DeWch6d 0 Condo/townhome (single family attached) 0 Duplex
Multifamily (apartment) O Garage
If commercial, is It: 1 ❑ Bank 0 Bar 0 Church ❑ Hotel/Motel O Medal office ❑ Office 0 Retail
0 Restaurant O Other (explain)
Is this building 50 years of ape or more? O Yes O No If yes; you may need to contact Historic Pressrvabon
If this is for a demolition permit, what year was the building constructed?
If pnbr to 1923; ytw wi// need an asbestos apt to submit with thls appolobon.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: ltst the company name or O7y of Collins l/crr w p
Electrician Plumber MediaPocal Roofer Odw
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 k has been pail and Issued.
print Name
Applicant: Al hi'19 dr-f-t'zti? sin re ` hate /,,�
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