HomeMy WebLinkAbout909 Chippewa Ct - Applications/Air Conditioner - 07/14/2011AUG-06-2011 15:38 From:Allen Service
City of
Fort Coltin.,c
OVER
This application is to be used
❑ Demolition (interior non-struc
d Heating Unit ❑ Lawn Sprinb
❑ Ventilation ❑ Water Heater
manufacturer).
Complete all applicable inforr
Application irk
For office use o
-970-484 4448 To:92246134 Pa9e:2�13
Planning, Development & Transpartation
281. N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
THE -COUNTER PERMITS ONLY
3 apply for the following permits only (check all that apply)._''
Conditioning
ral) ❑ Electrical Alteration (not service change) 0 Gas Lighter Gas Log
r ❑ Mobile Home replacement 0 Roofing 0 Sewer Line ❑ Photo -voltaic
Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make. model and
on the application. Incompleta applications will not be accepted.
S ILI Date 7 �Y //
5
Job Site Address (required)
Value of Construction (labor, materials, profit)
6 ' w
o Jaws
diMI-o0
Property Owner Name
Address
City/State Zp
Phone
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
sr
Tax rr
5 CCU to s �
Are you paying taxes here or by report?
q gq qS
❑ Here Report
Contractor City of Ft. Collins Sales
Sales tax number is required by all contra
_mrs.
Are you paying with your trust account?
g Yes ❑ No
Is this a residential or commercialproject? esidendal O Commercial
/❑
If residential, is it: Single Fa ily Deta ed ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Sar ❑ Church p Hotel/Motel ❑ Medical office 0 Office ❑ Retail
❑ Restaurant O Other (explain)
Is this building 50 years of age o more? ❑ Yes 0 No If yes, you may need to contact Histnric Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you Pvill need on a bestos assessment to submit.with this app1ic36c-n.
Description of work
/%A .. . ^ .1
*If lawn sprinkler/backflow prevented must list licensed plumber. if first-time A/C, must list licensed electrician.
Subcontractors: List the Cornpdny 4dme or City of Ft Collins license ,#
Electrician Plumber I Mechanical Roofer Other
I hereby acknowledge that 1 have re a 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.
6r(1
Print Name: 611 1� Date
Si natur
9