HomeMy WebLinkAbout931 FOSSIL CREEK PKWY - APPLICATIONS - 11/16/2016_ / 15 / W1-5-Z016011: 37AM ";Qm-
TO:19702246134 FROM:710�&J75J34 T-610 'HINT 1F-ZH
,J�ort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO $0524
Phone 970-416-2740 Fax 224-5134
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 applic�ablle information on the application. Incomplete applicatio
ns will not be
accepted.
Application # it A �Uo Zl 0U Date III 90)(0
Forof!rce use only
Job/ Site Ad s (required
Value of Construction (labor, materials, profit)
l
Property Ow er
Addre s
City/State Zip PhoneI
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Applicant Name
Fort Collins Heating and Air
Address
208 Commerce
Ci /State Zip Phone
Dr. #4 Fort Collins, CO 80524 (970) 105-1478
Contractor
Address
City/State Zip Phone
Fort Collins Heating and Air
208 Commerce Dr. #4 Fort Collins CO 80524 970484-4552
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
SalestaxnumberistWuhWbyj11conftvcf x
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank CI Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain) .
Is this building So years of aye 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
V 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 9
Electrician 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.
Applilcant:
Print Name: Angela Morrow Signature
Date I lr 1V16