HomeMy WebLinkAbout1207 Dorchester Ct - Applications/Furnace - 06/05/2018&t Cityof Planning, Oevelopmen4 & Transportation Services
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 Q Vim
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
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voltalc
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood(Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application.
Application # ,( ' 14
fAfte use only
]ob Site Address
Name _ Address
Address
Contractor Address
Contractor City of Ft. Colline dales Tax #
.S3kstax numberLsrequIledbystl _tlAo
v
Incomplete applications will not be accepted.
Date
Value Conatrttetion (labor, materials, profit)
11 nv:�IIC
Phone
Zip Phone
Zip Phone
Are you paying taxes here or by report? ❑ Here ■ Report
Are you paying with your trust account?. ■ Yes ❑ No
Is this a residential or commercial project? 1! 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 50 years of age or more? O Yes ®No Ifyes, you mayneedto mnbctHisWcprese7vafon
If this Is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
Subcontractors: L& the companyname or OYy of Collins /!sense 0
Eeriidan_� Plumber
Medranical Rooler 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.
Applleant: C 0 m C
Print Name^� W Q v r r t Signature Late �—
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