HomeMy WebLinkAbout3500 Rolling Green Dr - Applications/Furnace - 02/14/2017From:
02/13/2017 07:58 0501 P.001/002
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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
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 #may, I %6) Date ��1 1�-
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Narif4 Address City/State Zip Phone
Applicant Name Address `J City/State Zip Phone
Contractor Address City/State ZIp Phone
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? If .Report
Sales ra*number isrequired byall caVacmrs Are you paying with your trust account? XYes ElNo
Is this a residential or rcfal project? residential El Commercial
If residential, is it: ingle Family Detach ❑ Condo/townhome (single family attached) ❑ Duplex
❑ 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? ❑ Yes CI 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 asbeslas assessment to submit with this app/Jcaoon.
Description of work
*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 ,C
Electrician Plumber
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: (1\LMP G%\%VV%, Signature (�
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