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HomeMy WebLinkAbout1630 Silvergate Rd - Applications/Air Conditioner - 07/16/2012Ci-L'y of Fart Collins Planningr Development &Transportation 7_tll N. College rave P.O. Box 560 Fort Collins, CO B0524 Phone 970-416-27elo Fax 224-6134 OYEWTNE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). Q Air Conditioning ❑ Demolition (interior non-structural) 0 Electrical Alteretlon (not service change) ❑ Gas Lighter 0 Gas Log ❑Heating Unit CI Lawn Sprinkler 0 Mobile Home replacement 0 Roofing ❑ Sewer Line Gl Photo-voitalr, ❑ Ventilation a Water Heater ❑ Water Line Cl Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Application # &)(;zu J7xOMCe usie 070t Incomplete applications will not be accepted. Date � ,.�1ia4 _ Sob Site Address (ra r.Artd) Value of construction (labor, materials, profit) �e Property Owner Name Address City/State ZIP Phone c Applicant Name Address City/State ZIP Phone l= C corn r . ' 9 F:::'-CCn Ru5�9qifyi Contractor Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here AReport &ikg rr7Xm/mtkr'rs &NA*rdbydfiow*;;vcw& �_ l a G Are you paying with your trust account? ')Q Yes 0 No Is this a residential or commercial project? ❑ Residential ❑ C.ominPrcial If residential, is it: D Single Family Detached ❑ Condo/townhorre (single family attached) 0 Duplex © Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar Cl Church ❑ Hotel/Motel ❑ Medical office 0 Office 0 Retail 13 Restaurant 13 Other (explain) Is this building So years of ago or more? 13 Yes ❑ No .IF^ ynumaynaedto n,»►aClrHrsttMCl3t rwabFart If this is for a demolition permit, what year was the building constructed? I(Aritx• lv J97S, YOU Mt gyH,aliwr. Description of'work -ir hewn sprinklerJUaWI0W preventer, must list licensed plumber. If flrst-time A/C, must list licensed electrician. SubcontraCtors: L&I't e(VM1Aavn,,7mcor0irnirm"nslicewel,,,r Elcetrleian - Phmber Medwnkal t! ('�V-1 6- Roofer __ Other I Hereby acknowlr-rage that I liavp read Lhis application and state that Lhr. 01)ove inrorm0t'lon 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: (,?� 4],� jVJgSlgna re ` 7 rt- Date