HomeMy WebLinkAbout143 N MCKINLEY AVE - APPLICATIONS - 12/6/2018Planning, Development, & Transportation Services
Fort Collins 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). j 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 I j Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all app ' able information on the application.
'r6l -
Application # 5-io
For oli<ce, use only
Job Site Address (required)
Incomplete applications will not be accepted.
Date
Value of Constrijction (labor, materials, profit)
Owner Name IAddress City/State Zip Phone
Applicant Name
Address
t City/State
Zip
Phone
Fort Collins Heating & Air
208 Commerce Dr. #4
Fort Collins, CO
80524
Contractor
Address
City/State
Zip
970.484.4
Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 0 Report
Sales(axnurnberisIequrredbyall contactors. ^� Are you paying with your trust account? 4 Yes ❑ No
IS this a residential or commercial project? �Z Residential ❑ Commercial
If residential, is it: 'Q Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Muldfamily (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 yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backflow 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 #
ElectridanD� 1\ 1 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: /� D me
Print Name: A 2eYftc� Signature r L,
Date_
R.YIblUlldale 21612i11 r