HomeMy WebLinkAbout2517 Tulane Dr - Applications/Furnace - 06/26/2018-dclka1s
FC'ty of Inrnng, Development, & Transportation Services
ort 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) 141ir Conditioning
❑ Demolition (interior non structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
40ieating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation '1 JateOV901
Water Line ❑ W°� d�/Pellet Stove (must be EPA certified provide make model and
manufacturer)C I_ W" `l�f
Complete all app�lr2cable information on the application Incomplete applications will not be accepted
Application # u 1b0 S d L0 — to Date i n
For office use on/y � I `C )D S O� ^�I
Job Site Address (required) Value of Construction (laboL materials profit)
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Property Owner Name Address City/State Zip Phone
iyz&NS�
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by reports $Mere ❑ Report
Sales tax number is rmurred by all contactors Are you paying with your trust account? yNes ❑ No
As s
Is this a residential or commercial projects Nyesidential ❑ Commercial
If residential is it Y: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 morel ❑ Yes ❑ No If yes you may need to contact Histonc Preservation
If this is for a demolition permit what year was the building constructed?
Description of wor `VJ
*If lawn sprinkler/backflow preventer must list licensed plumber If first-time A/C, must list licensed electrician
Subcontractors List the company name or Gty of Ft Collins license #
Electncian 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 �—
Print Name QXt,a.,t?NAV Signature au.-i.D Date
Rehsw uat ZW2017