HomeMy WebLinkAbout5001 Sawhill Dr - Applications/Furnace - 04/17/2018.Foit Planning, Development, & Transportation Services
rt Collins Community Development & 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
M Heating Unit 0 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 # E)�CC)oaQ-1 (0 Date
For of ke use only
Job Site Address (required) Valuq of Construction (labor, materials, profit)
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-Property Owner Name Address City/State Zip Phone
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-Ap Iicant Name Address Oty/State Zip Phone CW
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Contractor Address City/State Zip Phone
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Contractor City of Ft. Colli les Tax # Are you paying taxes here or by report? ❑ Here ■ Report
Sales tax number is required by all mnhactors I?D\C `, Are you paying with your trust account? 0 Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ®No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backfbw preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license 0 /�(]�
Electrician Plumber Mechanical 1 ��.'� t 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: I
Print Name. n i rgnature M Date
Reunion date 2AR017