HomeMy WebLinkAbout905 ELM ST - APPLICATIONS - 4/3/2018 (2)Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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
EI 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 applicable information on the application. Incomplete applications will not be accepted.
Application # U lil?) 0 Q 59 0 Date
For office use only
04/03/2018
Job Site Address (required)
Value of Construction (labor, materials, profit)
905 ELM ST
$2,670.00
Property Owner Name
Address City/State Zip
Phone
MARGARET SCHNEIDER
41632 COUNTY RD 13, FT COLLINS CO 80524
970-482-8598
Applicant Name
Address
City/State Zip
Phone
Contractor
Address I City/State Zip
Phone
NORTHERN COLORADO AIR INC.
812 STOCKTON AVE, FT COLLINS CO 80524
970-223-8873
Contractor City of Ft. Collins Sales Tax
# Are you paying taxes here or by report?
O Here ❑ Report
sales tax number Is required by all contractors.
Are you paying with your trust account?
❑O Yes ❑ No
26862
Is this a residential or commercial project? El Residential ❑ Commercial
If residential, is it: O 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 If yes, you may need to contactHistoric Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work REPLACE FURNACE 95%
*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 .#
Electrician Plumber Mechanical 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: KARENA HUNTWORK Signature
KARENA
HUNTWORK .^° RENAHa AGA� aUS
aK ro„ ,
Date 04/03/2018