HomeMy WebLinkAbout3215 Ledgestone Ct - Applications/Furnace - 08/22/2018a lwva
6City of Planning, Development, d Transportation Services
r$ 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). Wir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
`l:eieating 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 information on the application. Incomplete applications will not be accepted.
Application # 2 I gclao elz Date _ a Ak
For oh% use only
lob Site Address (required) Value of Construction (,labor, materials, profit)
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Property Owner ame Address City/State Zip Phone
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Applicant Name Address u City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? %Here ❑ Report
Sales tax number is required by all contractors. Are you paying with your trust account? files ❑ No
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Is this a residential or commercial project? ttesidential ❑ Commercial
If residential, is it: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
LJ 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 No If yes, you may need to cvntac-tHistoric Preservation
If this is for a demolitio , hat year was the ilding constructed?
Description of or -k. & f
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Fr.Collins license #
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:
Print Name:Signature a" Date
Revisim dale 2/60017
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