HomeMy WebLinkAbout920 N MASON ST - APPLICATIONS - 12/2/201515R522
City of Planning, Development & Transportation
F6} 281 N. College Ave P.O. Box 580
r6 Colons 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# 12.�,lSC��3S7oS•
For offte use only
Date 12/02/15
.4 /v 4. 99
Job Site Address (required)
Value of Construction (labor, materials, profit)
920 N Mason St
3550.00
Property Owner Name Address
City/State Zip
Phone
James Raffone 920 N Mason St
Ft Collins CO 80524
203-444-1986
Applicant Name Address
City/State Zip
Phone
IMS Heating and AirnngsBerthoud.
CO R0513
970-532-0123
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number Is required by a//mntractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: ID 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?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Reolace Furnace
*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 licenser
Electrician Plumber Mechanical IMS_ Ha_ a_ting_ 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: Rita I Ilhrinh
Date 12/02/15