HomeMy WebLinkAbout371 Kalkaska Ct - Applications/Air Conditioner - 04/24/2013FROM :NCA
Faart of
FAX NO. :9702299983 Apr. 19 2012 03:06PM P2i3
Planning, Development & Transportation
281 N. College Ave P,O. Box 580
Fort Collins, CO 60524
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
El Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater rl 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 # N -30 I`C00 Date
For office use only
Job Site Address (required)
y Value of Construction (labor, materials, profit)
LrG
Property Owner Name Address
_ city/State Gp Zip
Phone 3
ti
S,C?-g a5
Applicant Name Address
ity/State Zip
Phone
S
Contractor Address
City/State Zip
Phone q �
w+Y�✓ YIC, QlIS
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here XReport
Sales tax number is r*quired by all contractors.
Are you paying with your trust account?
XYes ❑ No
sx W �e z.
Is this a residential or co mercial project? ZResidential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
iff Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank 13 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)_
Is this building 50 years of age or more? Q Ye5 o If yes, you mayneed to contactH1storicPreseruation
If this is for a demolition permit, what year was a building constructed?
Ifpr/or to 1975, you wi// need an asbestos assessment to subm/t with this application.
Description of work
*If lawn sprinkler/backfbw preventer, must list licensed plumber, Ir first-time A/C, must list licensed electrician.
Subcontractors: List the cgmpany name or City of Ft Coll/ns //tense 0
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 Nam
Date