HomeMy WebLinkAbout143 N MCKINLEY AVE - APPLICATIONS - 12/6/2018 (5)F�-'k! Planning, Development, & Transportation Services
ort 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). ❑ 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 applicab or tion on the application.
Application # I 461�
For office use only
Incomplete applications will not be accepted.
Date
Job Site Address (required) Value of Constr ction (labor, materials, profit)
� I` INC, �.
Property Owner Name Address City/State Zip Phone
2W r , P r� x
Applicant Name Address City/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 Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here E4 Report
Sales tax number is required by all contractors. n A W Are you paying with your trust account? 0 Yes ❑ No
Is this a residential or commercial project? N 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 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work bc 0 n C D v K �V oc Q
*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 fi
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.
Applicant:
Print Name: ft , C(13yllSignatureJ//������y�l1,+ l — Date o
Revision dale 2J&12017