HomeMy WebLinkAbout2407 Kodiak Rd - Applications/Furnace - 07/25/2018Cltyof
Fort Collins
Planning, Development, & Transportation Services
Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970A16.2740 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). ❑ 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 ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Informationonthe application. Incomplete applications will not be accepted.
Application # `JOS q �J Date 7 e ZS , 1$
For offlae use only
]ob Site Address (required) Value of Cppstruction (labor, materials, profit)
Property Owner Name Address City/State ZI Phone
Qbotl
Applica Name Address City/statep Zip Phone
Y ICI Y
Contractor g-
Address City/ to Zip Phone
Y {
Contractor City of Ft. Collin§alaies Tax # Are you paying taxes here or by report? ❑ Here ■ Report
'Wes WxnumbffIsre40WbyaBconbadors rl,`gC D Are you paying with your trust account?. ■ Yes ❑ No
Is this a residential or commercial project?Jl 61 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? ❑ Yes ■ No ifyes, you may needto contact n1sroricprewrvarfon
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backt1ow preventer, must tilt licensed plumber. If first-time A/C, must 11at licensed electrician.
Subcontractors: ustMecompany name ora1YofRW11hsIkense9����//��
Electrician Plumber. Mechanlml_Q 1 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.
PPplicant:
ntName:�1W�'i �Q C V 1iIL Signature
l)abe 1
Refton dale 2JO2017