HomeMy WebLinkAbout5220 Parkway Cir - Applications/Furnace - 06/19/201806/19/2018 3:40PM FAX 9704844373
IA000110001
FotrtCollins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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
❑•Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line 13 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable informrratiioonn ontheapplication. Incomplete applications will not be accepted.
Application #''
_ w OV� `� Date
For ofce use only ,
Sob Site Address (required)
527P #Lf Oir6, F6441 Iue of Construction (labor, materials, bus
811.616
Property Owner Name
Address City/State Zip Phone
51U tOMM M, br. EYE aiUa 0 DNA 940-4T4-4440
Applicant Name
Address City/State Zip Phone
C-enot1:rl
Contractor
Address City/State zip Phone
WLt
);;W+CcitJn5
cE'
o ommxj� r, 9 �
Contractor City -of Ft. Collins
4ales Tax # Are you paying taxes here or by report? O Here 0 Report
Sales number isrequIredbya#conrrarram Are you paying with your trust account? JQ Yes ❑ No
ytax
�7 �] ( J
Is this a residential or rprnmercial project? Residential ❑ Commercial
If residential, is it: A_ ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) CI Garage
If commercial, Is It: 0 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office C] Retail
❑ Restaurant ❑ Other (explain)
Is this building,50 years of age or more? . ❑ Yes,-VNo Yyes, you may need to contact Historic Pmservat/on
If this is for a demolition permit, what year was the building constructed?
Pfprior to i975, you W11 need an asbestos assessment to submit with this appl/catlon.
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 Ca'ly of Ft Codlns license 0
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: C.r! / / s, - L 1 /� 1 V
PrintName:�y Signature (/t/yV'�p Date 6't 11