HomeMy WebLinkAbout1708 Pecan St - Applications/Furnace - 07/24/2019City 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement IJ 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 th�ep application. Incomplete applications will not be accepted.
Application # �� S 1 Date ! i 1 9
For offlce use only <i C11 )L Coss H S 7 S aq e c�
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip hone
GVeQVI hD�b e i%r- Cc>l CD RD52b c)-2Z1-3 b
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip -�DS"Z t_� Phone 9 7p
C M3g5DOIDZicy/ 2&> For4Co/Ii�t5 .2?2--?2Z
Contractor City of Ft. Colli s Sales Tax # Are you paying taxes here or by report? P'Here ❑ Report
Sales tax number is required by allmntractors Are you paying with your trust account? ❑ Yes Flo
Is this a residential or commercial project? 50tesidential ❑ Commercial
If residential, is it: )R: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 0 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 •-Lc�c
*If lawn sprinkler/backfiow 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: Cif�Q\P 60kP Si ure Date 7 ZJ/6('