HomeMy WebLinkAbout3743 Carrington Rd - Applications/Furnace - 02/15/2017Planning, Development & Transportation
City of 281 N. College Ave . P.O. Box 580
jp ort c.hire 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 Alteratlon_ (not service change) ❑ Gas Lighter ❑ Gas Log
Cleating 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, modal and
manufacturer).
Completeall applicable information on the application. Incomplete applications will not be accepted.
Application # I �y) Date- 15 111
Fnr nffm use only
Job Site Address (rrquGed).
Valve of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip Phone
pliant Nam
Ad
City/State Zip Phone
Contractor
Address
dity/State Zip Phone
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Contractor dty of FL Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here `+Report
Are you paying with your trust account? Ves ❑ No
tips cvi number/sia9uheSbya0mn6acl4rs
Is this a restdentlal or eoinmerdal project? residential 0 Commercial
if resI entlal, Is It: <$Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multlfamlly (apartment) Q Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑. HobPi/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain)
is this building So years. of age or more? ❑ Yes , ❑ No rfye4 you may need in contact H/storicPmwivatJon
If this is for a demolition permit, what year was the building constvcted?
If poor rn 1975, }rou wl1%need an ashes os ass men[ to svbin/f wilh bh/s application.
Description of work
*IF lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Cty of Ft Collins /!terse #
Electridan Plumber Med,anl,al_ PworeJ 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: Y(%)��1rC R►iaprint Name rl.�gnature.__Qa13M%z-5- /I