HomeMy WebLinkAbout2907 Bluegrass Dr - Applications/Furnace - 05/06/2019Ll 4 1 a -
Fort of
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 # 2 � 9ta) U l4
For office use only
Date SV (01 07O l q
lob Site Address (required)
Value of Construction (labor, materials, profit)
LA
Property Owner Name Address
City/State Zip Phone
v
$ -44�L- 7
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
cc- 3q.5 aer
pis&5QS 4 4,76- j j1
Contractor City of R. d1lins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax number Is required by all contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? `d Residential ❑ Commercial
If residential, is it: Q 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you wi//need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/badcflow 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 Medianiml 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: �' Signature
Date 1� W