HomeMy WebLinkAbout2218 Mathews St - Applications/Furnace - 04/05/2017From:
04/05/2017 02:14 #563 P.001/001
City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
;art Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to ipe 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
CRieating 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 # �� D 1 � to 4 Date y1y� n
for ofce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
3�E
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
a
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? WHere
.Report
Sales tar number & 1equired by all contractors.
Are you paying with your trust account? XYes
Ci No
Is this a residential or commercial project? loResidential ❑ Commercial
If residential; Is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
I7 Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar 0 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
D Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes O No If yes, ynu may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you willneed an asbestos assessment to submit with this appllcation.
Description of
-it lawn spriniaer/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of Ft Collins license f
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: cam' /1
Print Name: ` `.00\Q - Qyior-irv. Signature Date J