HomeMy WebLinkAbout215 Egyptian Ct - Applications/Furnace - 03/10/2020F*City of Planning, Development, & Transportation Services
�rt 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 ❑ 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 #_`�l7 (�� Date���rz�sTQ�
ForoAine use only
]ob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Tip yg�P.h ,ne
5ZS
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Rmllki
Contractor City of Ft. Co [ins Sales Tax # Are you paying taxes here or by report? I Mere ❑ Report
Sales taxnumberis mgrrlredbyall mnbracr Are you paying with your trust account? W(es ❑ No
Is this a residential or commercial project? esidential ❑ Commercial
If residential, is it: Oingle Family Detach ❑ 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 Histodc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/badAiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty ofHCoibnshcense #
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: *ti��e- ����`rr. Signature (Nz.L Date ���O�ZOZc�
R"sim Cate 9&2017
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