HomeMy WebLinkAbout1906 Dorset Dr - Applications/Furnace - 06/21/2018=i;yof Planning, Development, & Transportation Services
r: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).;yAir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating 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 aepi[cf ble Information op the a plication. Incomplete applications will not be accepted.
Application # �'fSA —I Ig S Date (--_) i' -J8
Fo Arce use o /y
Job Site Address (required) Value of Construction (labor, materials, profit)
1106 Do se+ Or, 45757
Property Owner Name Address City/State Zip Phone
5 ue.l A W o_54epi &e6l 1q0C DWS F Co /V f3osd6 /SS 3/a-6 0
Applicant Name Address City/State Zip Phone
DotAie, Lan S. L e a Ave - y6, 8OS-aLl
Contractor Address City/State Zip Phone
tread. Gv f fhe " '` 2 --Bf -8208
Contractor aty of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here eport
Sales tar number is required by allconnactnn. Are you paying with your trust account? Yes No
6013 ro0yl
Is this a residential or commercial project? Apesidential ❑ Commercial
If residential, is it: rSSingle 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? ❑ 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 o ork i -Fur ace. w,44 6o K BTU 60b cu
:CV( J -E Q
*If lawn sprin r/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the coom any name or Cty of Ft Collins license #
Electrician 1NI �Cd €/ 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: ff11
Print Name: Dojlni Cana Signature Date 6-a1-160
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Revision data 2/erz017