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HomeMy WebLinkAbout2641 Somerville Ct - Applications/Air Conditioner - 12/18/2012FROM :NCA FAX NO. :9702299983 Dec. 19 2011 01:15PM P11/11 Fart Cottins 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 applyVEM Air Conditioning El Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Light Gas Log 0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater 0 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 # 1 � I `�► 1 �" � Date ��f�� ` (7 � 2 —1 For office use only �1 S- 00 Sob Site Address (required) Value of Construction (labor, materials, profit) Property Owner Name Address City/state Zip Phone 1 11 P ✓l3 �✓� l l l3 It tl t �C.�.+�e e_ Applicant Name Address City/State Zip Phone Contractor Address City/State Zip ne cl-to k)ov,'A-%.ovY)U1oyyLcAnA inc. Q Z5 L Calf �0 2 Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here XReport Sales tax number lspt,wulredbyallcvntradols Are you paying with your trust account? l(Yes ❑ No oz 1p 0 Li' 2— Is this a residential or commercial project? OrResidential ❑ Commercial If residential, is it: U Single Family Detached © Condo/townhome (single family attached) Duplex ❑ Multifamily (apartment) ❑ Garage / If commercial, is it: ❑ Bank ❑ Bar 0 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? Dyes O No If yes, you may need to contact Historic Preservation If this Is for a demolition penult, what year was the building constructed? Ifprior to 1975, you will need an asbestos assessment to submit with this app(icaVon. Description of work *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: '',,LL (11t the company name or City of Ft Collins license 0 Electrldant �✓ l/1_.._._ Plumber Mechanl©l RooferOther 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 Nam Date --F -1CL_