HomeMy WebLinkAbout1318 Coulter St - Applications/Furnace - 02/15/2017' 115 f J& 15-ZU I T 11:30PM PS;ONF
TO:19702246134 FROM:710�V4J7�34 T-705 "Whol F-Z57
of
Fort G0ltins
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
❑ Heating 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 informap"on on the application. Incomplete applications will not be accepted.
*,r-v'mi+o homeowner * r-eGeip-i In 6�,FI l
Application # Date
for ofl9ae use o►ly . l
Sob Site Address (required)`
Value of Construction (labor, materials, profit)
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aOwner Name Address
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City/sta Zip Phone (303)
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Applicant Name Address
Fort Calling Heating and Air 209 Commerce
City/State Zip
Dr #4 Fort Collins. CO 80524
Phone
(97OLU5-3478
Contractor Address
City/State Zip
Phone
Fort Collins Heating and Air 209 Commerce Dr. #4 Fort Collins CO 80524
970 484-4552
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
SON tAw nwnberisreq~byalicw,tractas:
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or Commercial project? EPResidential O Commercial
If residential, is it: 4single Family Detached ❑ Condo/townhome (single family attached)
0 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
O Restaurant ❑ Other (explain)
Is this building 50 dears of age or more? ❑ Yes O No If yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbeslas assessment to submit with this application.
Description of work
❑ Duplex
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontiaetors: list bye company name or City of F? Collins license »f
Electrician Plumber Mechanical H1309 Roofer
Other
I hereby admowledge 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. An ela Morrow Signature Date �j/•J�� /