Loading...
HomeMy WebLinkAbout3756 Sandy Shore Ln - Applications/Furnace - 03/22/2018From: 03/19/2018�, 02:21 #941 P.001/001 r1 Cit of � Y Planning, Development, & Transportation Services Fort Collins Community Development & Neighborhood Services �7281 North College Avenue Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134 I u OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). Conditioning ❑ Demoiftlon (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log eating Unit ❑ Lawn Sprinkler ❑ 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). U Complete all applicable information on the application. Incomplete applications will not be accepted. $1ghcl 113 sZ Appliacation * 7!> 1 t'>©1 b 3 3 Date 3 1 For oftv use only ]ob Site Address (required) Value of Constructio�lab'r,materials, profit) Property Owner Nan9e Address City/State ;ZIP Phoo `e , `3- sr Appl" nt Name Address City/State Zip Phone Contractor Address City/State ;Zip Phone Contractor City of It Co ins Sales Tax # Are you paying taxes here or by report? $34ere ❑ Report •sanesraXnwnbffh;Mvuaadbyall aw*actws Are you paying with your tnjst account? J!PYes ❑ No 3tr�S Is this "a residential or mmencial project? residential ❑ Commercial If residential, is it: [Pingie Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage I If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Mote! ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building SO years of age or more? ❑ Yes Lf No Ifyw, you may need to contact Histndc Preservation If this is for a demollbon permit, what year was the building constructed? Description of work n *If lawn sprinider/baddtow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or 01y of Ft ChMnts Ikense 0 Electrician PlumterMechanical Roofer other I hereby acknowledge that I have read this application and state that the above Information is complete and correct. I agree to oomply'wtth 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•S�!L*U•tM. G1q�_ Signature �a'�,� paw r a RevWw dery �IZOMI7 N h�