HomeMy WebLinkAbout2318 Tanglewood Dr - Applications/Furnace - 03/11/2019City of Planning, Development, & Transportation Services
Fort 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). )[J Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement [I 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.
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Application # f�)I'�JI
For office use only
Date 3, ff l q
Job Site Address (required) Value of Co struction (labor, materials, profit)
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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 Ft. Collins Sales Tax # � _.neyou�avin4 taxes here or by report? Here eport
Salestaxnumberisrequiredbya//con6actnrs Are you -paying with your tr account? ❑ Yes ❑ No
Is this a residential or commercial project? lResidential ❑ Commercial
If residential, is it: WSingle 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 If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work RVCACZ: 11E� or )ajt -11AY 'J X� ®C�
*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 At 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 conect. 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 �`�1 - J `�� \ Signature Date �0
Print Name: g /I
Revision date 2DG2017
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