HomeMy WebLinkAbout6266 BUCHANAN ST - APPLICATIONS - 2/3/2016 (2)FEB-03-2016 10:36AM FROM -
9704848354 T-276 P.001/002 F-054
art Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 131 U Ob ( Offi Date
For ofte use only
Sob Site Address (required)
2PArlumn A
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
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Applica t Name Address
City/State Zip
Phone
Fort CollinS Heating and Air 209 Commerce
Dr. 44 Fort Collins. CO 905')4
9
Contractor Address
City/State Zip
Phone
Fort Collins Heating and Air 208 Commerce Dr. #4 Fort Collins CO 80524
970 4 4-4552
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number &iWvAadbyall contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? $Vtesidential ❑ Commercial
If residential, is it: - I&Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Hank ❑ Bar ❑ Church d Hotel/Motel ❑ Medical office ❑ Office d Retail
❑ Restaurant ❑ Other (explain) _
Is this building SO 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 pn'or to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subeentraeto : Ust the company name or Clly of Ft Collins license 0
Electrician M11Plumber Mechanical HI309 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: Aneela Morrow _ Signature
Date V3/16