HomeMy WebLinkAbout815 Sitka St - Applications/Furnace - 06/26/2019City 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). 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 # 6yMd52�,$ 6,AC �I Date (� 1 ao i9
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
its S1 1 4 LEO
Property Owner Name Address City/State Zip Phone
�harar. �uk_k� $15 S��ka s�. T--k. Callins C 9659 o-q R
Applicant Name Address City/State Zip Phone
n.zv& ,�_tn4 ob s+,43 ree Cd Sol"5I 97b-4zo-7Z33
Contractor Address City/State Zip Phone
e041 boa PQ,,J 54.�3 C6 goLi31 g7D-353-6315
Contractor City of Ft. Collins 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? ❑ Residential ❑ Commercial
If residential, is it: M 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?
Description of work Fv. no,ce. nv-\A A� r Cffy\J �ray-,Qy- Replace, vw-ev\�
t ah l d/-_'n (BTU. Fso%6 { L,4-y- ,au ma y , 066 8 rt t Ue 5kp1pr-
*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 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
Revision date 216/2017 � V 1