HomeMy WebLinkAbout4050 Newbury Ct - Applications/Furnace - 04/01/2019City of Planning, Development, & Transportation Services
F®rt Colons 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
"eating 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 infor}maIll
l/non the application. Incomplete applications will not be accepted.
Application # V Ogg
l�� J Date i kol
For office use only
lob Site Address (required) Value of Constructioon� w(labor, materials, profit)
Y�
Property Owner Name Address City/State Zip Phone
20s--;& s
02
Applica Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of R. Co ling Sales Tax # Are you paying taxes here or by report? Mere ❑ Report
Sales tax number lsrcquiredbyall contradars Are you paying with your trust account? PP17es ❑ No
2ACQD5
Is this a residential or commercial project? toesidential ❑ Commercial
If residential, is it: Vk Single Family Detacheb ❑ Condo/townhome (single family attached) ❑ Duplex
ff 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 Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*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 #
Sectridan 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: \ Date { l k
Print Name:��fy��Q., G\�l�`K% Signature ��,9 -D h
Revision dale 2 I2017
31