HomeMy WebLinkAbout612 S COLLEGE AVE - APPLICATIONS - 1/3/2018,krcity0f P/annIng, Development, & Transportation Services
-�Ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.418.2740 Fax 970.224A134
OVER-THE-COUNTER PERMITS ONLY
This appllcation Is to be used to apply for the following permits only (check all that apply). O Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) O Gas Lighter ❑ Gas Log
■ Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement 13 Roofing ❑ Sewer tine ❑ Photo-voilabc
D 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 # eA CC) 0003D Date I l 3 I
foroAke use ony
lob Site Address (a qulmd) Val of Construction (babor, mawa% profit)
e Ibloup
Property Owner Name Address CI /State ZI Phone M
Applicant Name Address Clty/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor Address city/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor City of FL Colons Sales Tax # Are you paying taxes here or by report? ❑ Here i Report
saw arnumberisregt*wby&#ca*acfors /L�►(] p Are you paying with your trust account? ! Yes ❑ No
Is this a residential or commercial projed, `? Jt❑' IResidential ■ Commercial
If residential, Is it: ❑ Single Fancily 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 yeaiw of age or more? ElYes a No If yes you may necid to contactH/stvdc pr&v&veb0n
If this is for a demolition permit, what year was the building constructed?
Description of work
Vlawn sprinkler/baddtow preventer, must list licensed plumber. If first-time A/C, must list licensed eleetrldam
Subcontractors:Ustthecompanyname orCity off? CoHnslkiense0
Mean Plxmber. MechaNcal H1309 Roofer pew
I hereby acknowledge that I have read this appkaWn and state that the above Inforrnatlon is complete and corecL 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 R has been paid and issued.
Applicant;
Print C
Print Name: �ffm"Millnature I `' Date
PmAdm mrteemr
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