HomeMy WebLinkAbout6266 BUCHANAN ST - APPLICATIONS - 2/3/2016FES-03-2016 10:36AM FROM-
9704848354 T-276 P-002/002 F-054
C r°C tCons
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) Q 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 # 'Bluonjacy Date
For offlee use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
266)
$ wo
Property Owner Name Address
City/Sta a Zip
Phone
1.
, MA el 6266 ew�mw_
t a oo��
292-W
Applicant Name Address
City/State zip
Phone
Contractor Address
City/State Zip
Phone
Fort Collins Heating and Air 208 Commerce M. #4 Fort Collins CO 80524 970
494-4552
Contractor City of It Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
4 Report
SaleStaxnumber rsrequired bya#contractors.
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? 3 Residential ❑ Commercial
If residential, is it: C 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 tfyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpdor to .075, you wi/I 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.
Subcontractors: Ust the company name or City of Ft Collins license of
Electra Plumber. Mechanical H1309 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: Angela Morrow Signature
Date 213116