HomeMy WebLinkAbout3005 Tulane Dr - Applications/Furnace - 02/23/201770 &-9
FO�1't�C011ins
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). O Air Conditioning
O Demolition (interior non-structural) O Electrical Alteration (not service change) O Gas Lighter O Gas Log
O Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement O Roofing O Sewer Line O Photo -voltaic
0 ventilation O Water Heater O Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Irrforrreation on the application. Incomplete applications will not be accepted.
Application # 6 1 -10 10 Li 5 Date Z3 - / %
For olae use on#,
sob Site Address (
hed)
Value of ConsbuctDion (labor, materials, profit)
Z005 /
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Property Owner Name
Address
City/State Zip Phone
i
Cl/ �005 % L Qi
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Applicant Name
Address
aty/State Zip Phone
Contractor
Address
City/State Zip Phone
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Contractor City of It Collins Sales Tax #
Are you paying taxes here or by report? )8( Here O Report
SAW Is bya#avrtracrom
Are you paying with your tent account? O Yes 13 No
Is this a residential or commercial project? '0 Residential O Commercial
If residential, is it: YSingle Family Detached O Condo/towrhome (single family attached) O Duplex
P Multifamily (apartment) E3 Garage
If commercial, is it: O Bank O Bar ❑ Church O HoW/Motel O Medical office O Office O Retail
O Restaurant 0 Other (explain)
Is this building 50 years of age or mare? O Yes O No ff yes, you may need to contact Historic PAtsanabon
If this Is for a demolition permit; what year was the building constructed?
lfprfor to 1975, you wil/need an a d eslas assemment to submit with th[s appIkabbon.
Description of work
*If lawn spdnlder/baddlow prevenber, must list licensed plumber. If first-time A/C, must list licensed electridan.
Subcontractors: tht the company name or Oty of R CbIlins /toanse 0
I1ecbtdan Plumber Mediardral 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 Nam
Date o7-023-/
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