HomeMy WebLinkAbout6327 Carmichael St - Applications/Furnace - 01/24/2017Planni6q, Development & Transportation
City of 281 N. College Ave P.O. Box 580
-• � " coolh s Fort Collins, CO 80524
"^•�q� Phone 970-416-2740 Fax 224-61-44
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
LR<eating 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 # LJl Date �-49-12
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Job Site Address (raquftd)
Value of Consbvctlon (labor, malai , profit) o
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Property Owne{ Name
Address
City/State Zip., hone
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pllcant Nam
Address
City/State Phone
Contractor
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Address
City/State Zip Phone
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contactor Clly of Ft. Collins Sales Tax #
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Are you paying taxes here or by report? ❑ Here ' i9Report
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Are you paying with your bust account? ',Yes ❑ No
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is this a residential or cor9merdal project? residential ❑Commercial
If residential, is It: 137egingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Murd%mlly (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Mabel ❑Medical office ❑ Office Cl Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No 11'yes, you may need to contact HlsivdePreservat/nn
If this is for a demoifdon permit, what year was the building constructed?
if prior fv 5975, yvu wI//need an asbantas asS&A n al7t lD subm/t w/th M/S appl/csUon.
Description of work
*Ir lawn sprinkler/backflow preventer, must list licensed plumber. Ir first�time A/C, must list licensed electridan.
Subcontractors: UstMe company name OfOryofFtGb//Inshcanse #
El,cbidan Plumber Mechanical Roofer Other
r 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 taws regulating building construction. 3 know that a
permit is not valid until It has been paid and Issued.
Applicant • r A
Print Nam
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