HomeMy WebLinkAbout3534 Riva Ridge Dr - Applications/Furnace - 03/22/2018From:
03/19/2018 06:24 #942 P.002/002
FCity of Planning, Development, & Transportation Services
ort Collins Community Development s Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 12ir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
O 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.
'FS 100 i8Z&
Application # 13(00 I S25 Date 3\NA\k
For of a use only
Job Site Address (requlred) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Co tins Sales Tax # Are you paying taxes hereor by report? $here ❑ Report
saAesraxnumber isnVu0wdbyammntractnrs. Are you paying with your trust account? des ❑ No
3s�ns
Is this a residential or commercial project? esidential Commercial
If residential, is it: Dingle Family Detach ❑ ❑ Condo/townhome (single family attached) 0 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office O Office 0 Retail
❑ Restaurant O Other (explain)
Is this building 50 years of age or more? ❑ Yes O No If yes, you may need to contact HLstodc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of worrZA Aft
*If lawn sprinkler/badfflow preventer, must list licensed plumber. If first -tame A/C, must list licensed electrician.
Subcontractors: List Me company name or G1y of Ft Collins Amme 0
EWctridan Plumber Mechanical Roofer Oyler
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.
Ppplicaft
riint Name:�yG\el,qy, Signature _�A461 to -g�`� Date 3
Revision We 2r.=17