HomeMy WebLinkAbout337 Saturn Dr - Applications/Air Conditioner - 06/19/2013FAX NO. :9702299983 Jun. 19 2012 02:50PM P2/2
Forcollins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 470-416-2740 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 O Gas Log
❑ Heating Unit O Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line El Photo -voltaic
❑.Ventilation ❑ Water.Heater ❑ Water Line ❑.Wood/P.ellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 6153o 3S Date l-0 - 161
For office use only
Sob Site Address (requlred)
Value of Construction (labor, materials, profit)
33--
2- MU
operty owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phone
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Contractor
Address
Cty/State Zip
Phone 9 -)t3
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Contractor City of R. Collins Sales Tax k
Are you paying taxes here or by report?
11 Here XPeport
Sales tax number is required bya#contrdct<Ms
Are you paying with your trust account?
f<Yes ❑ No
a kal.9.Z
�Is this a residential or c9mmercial project? Residential ❑ Commercial
If residential, is it: Single Family Detac ed ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar M Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explai )
Is this building 50 years of age or more? I7 Yes�No If yes you may need to Contact Hlstorlc Preservation
If this is for a demolition permit, what year was a building constructed?
If poor to 1975, you will need an asbestos assessment to subm/t with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Lot the company name or City of Ft Collins license .#
Electrician ✓ 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 Lp�19�13