HomeMy WebLinkAbout1420 Banyan Dr - Applications/Furnace - 03/18/2019i 6city. of Planning, Development, & Transportation Services
rt 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).,KAir 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 #Z 01inl 6 pI -Fc 'C Date _ _ 31� I I Aao1 `)
For office use only �IOI _ M
Job Site Address (required) Value of Construction (labor, materials, profit)
I o OAVmAtADr:ve RCON1 5 CU 11 63S-•30
Property Owner Nartie Address City/State Zip Phone
M; A44A SweP►ti? /920 CG 5cyo
Applicant Name Address City/State Zip Phone
SAP gectTv, boo >=NNf 1:t\4^ Or )off tcz11;.� Co 6oS;Y etetc(o
Contractor Address City/State Zip Phone
�IKe Ret-{ _L\c "I6M"v:,ile.n bf• 'I' (0'a frrt �i i�Pas fi i35 (gam,)
Contractor City of Ft, Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ,5Qepcirt
Sales tax number is required by all contractors Are you paying with your trust account? '.Yes .do
5-33 1 a
Is this a residential or commercial project? Residential ❑ commercial
If residential, is it: ASIngle 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? ❑ YesMNo If yes, you may need to ntact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work 7�vt,,Ilk 6 °d C'f kZTQ -,,,rAe,e.e IK S,?ee- 3.S4ovx AC
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list ensed electrician.
Subcontractors: List the companyname or Qy of Ft Collins license #
Electrician Plumber Mechanical eQ-Z 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:�PT2 6�+MYK� Cc>� 9 Signature Date $ t
Revision dale M2017
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