HomeMy WebLinkAbout2612 Shadow Mountain Dr - Applications/Furnace - 03/26/2019CltyC-f planning, Development, & Transportation Services
FOrt Collins Community Development & Neighborhood Services
— 281 North College Avenue
Fort Collins, CO 80524 Main: 970AI6.2740 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). jAA1ir 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 # S � C1 ` I� 0'0 'PL, Date
For office use only (bo m d l l l _ Al
]ob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
SMP I Nei �K� g600 02- F.:tC�Ib,s �o 10
Contractor Addressp� City/State Zip Phone
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Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report
Sales tax numberisrequiredbyallcontractois Are you paying with your trust account? $ Yes C"o
Is this a residential or commercial project? O-Residential ❑ Commercial
If residential, is it: jBI-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)R-Alo Ifyes, you may need to contactHistnric Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work 7r,5Fal1 10" b Wlc BTU f JAI 5>°•er "9,
*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 Ft Collins license #
Electrician Plumber Mechanical H- io0.2 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: 11 3
Print Name: �e C1t^ Y�1 Cc� O� Signature Date a�
Revision date 2/6/2017 G'/