HomeMy WebLinkAbout1001 Stonecrop St - Applications/Furnace - 08/08/2018Fort Collins
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 ❑ 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 # b IcO `b'�S Date 2- F - / F
For o/fbe use only
lob Site Address (regulnsd)
Value of Construction (labor, materials, profit)
"'Vela - 0 a
Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
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Contractor City of FE Collins Sales Tax #
Are you paying taxes here or by report? X Here ❑ Report
Sales Wnwnbensregwredbyall coaftadors:
Are you paying with your trust amount? O Yes ❑ No
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: ;ffSingle Family Detached ❑ Condo/townhorne (single family attached) ❑ Duplex
Multifamily (apartment) O 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? O Yes O No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you wi/I need an asbestos assessment to submit w&h th/s applirabon.
Desaiption of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of 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: /��e � Q
Print Name: �LY1g�! ,z Qd— ,' Signatu (�'IA�; • D ` o L pate