HomeMy WebLinkAbout2412 Ute Ct - Applications/Furnace - 05/07/2018Arl
City of Panning, Development, & Transportation Services
/-Fort 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). Conditioning
molition (i eriormon-structural) ❑Electrical Alteration (not service change) ❑Gas Lighter ❑Gas Log
Heating 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 t1he applicati Incco)m lete applications will not be accepted.
eviApplication #N3%QI�� l"" Da�W5
For of be use only
Job Site Address (required) Value of Construction (labor, materials, profit)
13-VC t �i Daa 0'
Property Owner Name Address City/State Zip Phone
La L23- -7(o7b
Applicant Name Address City/State Zip Phone
9 AJ10 NA-201
Contractor Address City/State Zip Phone
KIit\"1 A (2 12 aq /zovN-0 $Jim- 6z, jl o
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here jeport
Sales tax number isrequired byall araactws Are you paying with your trust account? ❑ Yes No
Is this a residential ormercial project? Residential ❑ Commercial
If residential, is it: 5rL
gle Family Detached ❑ Condo/bownhome (single family attached) ❑ Duplex
ltifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Histvdc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work NACE I 1AC /l.00449-
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed elecbiaan.
Subcontractors: List the company name or Ofy of Ft Coffin license #
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: /1 k /� a
Print Name: a �"� i Signature t Date U
Revision data 20SM17