HomeMy WebLinkAbout1408 Fuqua Dr - Applications/Furnace - 01/27/2017City o f,,,
-Ort Collins
Piarinblig, Develop3nent & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970.416-2746 Fax 224-6134
OVER-THE-COUNTER ER PERMITS ONLY
This application is to be used to apply for the foiiowing permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
bleating Unit ❑ Lawn Sprinkler ❑ Moblle 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 # R) n oo a 4 Date
G' nA?7 v „m nn/v
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Ap
"70009-
ILI v C Let- 'fir
Property Owner Name A
City/State Zip
Phone
1
Applicant NarA Ad
City/State 71p
Phone
Col tred6t Address
City/State ZIp
L
Phone
Contractor dty of Ft Collins Sales Tax #
Are you plying taxes here or by report? ❑ Here
Are you paying with you9r trust account? Ye5
`Report
❑ No
_ais ca%numberLsrequiredbya cwtractm-
,�eAlQ
Is this a residential or co merle? project? Residential Q Commercial
If residential, Is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) C] Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Mobel ❑ Medical of ce ❑Office ❑Retail
❑ Restaurant ❑ Other (e)plain)
Is this building So years. of age or more? ❑ Yes . 0 No if yes, you may need to contact H/stodcpreservatlon
If this is for a demolition permit, what year was the building constructed?
Ifpdor to 1975, you wil/need an asbestos assaswwtto stibmItWM thIsapp/iratfon.
Description of work U aY13
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Mecompany name orMyofRLbiiinsIkense#
Electridan Plumber Mechankal Roofer Other
r herby 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 slate laws regulating building construction. i know that a
permit is not valid until l`ft has been paid and issued.
Applicant:1 /Yt Y M
Print Name_ �!I z k n•�ignature