HomeMy WebLinkAbout3201 Silverwood Dr - Applications/Furnace - 07/09/2019FCity of Planning, Development, & Transportation Services
lirt Coth 1S Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80624 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
4 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation VNater 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 # ) RTOL�ti1 r� Date
Forofte use only hI la 0 )IQ ;a V
)ob Site Address (required) Value of Constaiction (labor, materials, profit)
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Property Owner Name Address City/State Zip Lk .Phone
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Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 03iere ❑ Report
sales tax number is- requvedbyall mnbadors Are you paying with your trust account? )P(es ❑ No
aid 111%
Is this a residential or commercial project? esidential ❑ Commercial
If residential, is it: 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 Ifyes, you may need to contact Histodc 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 orGly of Ft Collins Acense #
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.
Print Name:) fy Signature �Qq�4`� Date
Revision date 7J62617