HomeMy WebLinkAbout418 S WASHINGTON AVE - APPLICATIONS - 1/31/2018kFCity of Planning, Development, & Transportation Services
ort Whns Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.418.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits onty (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 O Sewer Line ❑ Photo -voltaic
❑ 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 # G I CO 00 Q U q
For oft a use only
Date I 1 3 I l � 9
Job Site Address (required) value of Construction (labor, materials, profit)
on
Property Owner Name, Address City/State Zl Phone.
Applicant Name Address ty/State Zip Phone r
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. 94 Fort Collins, CO 80524 970.484.4552
Contractor city of R. Collins Sales Tax # Are you Paying taxes here or by report? ❑ Here r Report
Ss'es taxnuaderir+e9u#W by a0mntrxmm !b 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 ❑ Bar ❑ church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes ❑ No If yesy you may need to contact Historic Pmwryatton
If this is for a demolition permit, what year was the building constructed?
Description of work Q Y
*If lawn sprinklerlbackflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or O y of R Collins lkense 0
Electrician Plumber Mechanical H1309 hoofer Other
I hereby admowledge that I have read this application and state that the above Infomlation 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.
Appncaft
Print Rome.I ASignature Date �JC7
Rerisim to 2182017