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HomeMy WebLinkAbout3002 W Elizabeth St - Applications/Air Conditioner - 03/26/2013City of 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 ❑ 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 # t� 1301 3 `onQ Date ) D ' �7 for office use only . <- ^ i � �Y1 Job Site Address (required) Value of construction (labor, m vials, profit) . .Z p. ropeQrty Owner Name Address city/state Zip Phone Applicant Name Address city/stateZip Phone ELRR 2-0 D 5� Contractor Address �`FG 4"N 20s commf c e City/State Zip -*q-1 Phone .04 .4567- Contractor City of Ft. Collins Sales Tax +t Are you paying taxes here or by report? ❑Here ❑Report Are you paying with your trust account?.>&Yes ❑ No Salasraxn bff' aquiredbyallcon&aCWrs is this a residential or commercial project? . IVuvc1lential © 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 (explal Is this building 50 years of age or more? ❑ Yes No if yes, you may need to contact Historic Preservah`on 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 *If lawn sprinkJer/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Ust the company name or QY of Ft Collins license 9 Bectrician 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. Y know that a permit is not valid until it has been paid and issued. Applicant: t Print Name} y `� Oats o . L PI