HomeMy WebLinkAbout413 EDWARDS ST - APPLICATIONS - 8/14/2017FCity of Planning, Development, & Transportation Services
it C011l115 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 applicop information on the application. Incomplete applications will not be accepted.
For affi a use only
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Site Address (rWillred) Value of Co dioon labor, materials, profit)
16
Property Owner Nam Address City/State Zip Phone
YI
Applicant Name Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce. Dr. #4 Fort Collins, CO 80524 970.484.4652
Contractor Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4652
Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report
Sales tax nwnberisraquiiedbya#conoactws Are you paying with your trust account? 4 Yes No
Is this a residential or commercial project? N Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) 0 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 ye4 you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Y
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed elecMdan.
Subcontractors: Lht the company name or OW of R Collins //tense #
Elecbidan Plumber Medlanicai H1309 Rooter 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 contalned 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: Signature Date
Re"M data 202017