HomeMy WebLinkAbout2502 Timberwood Dr - Applications/Air Conditioner - 06/24/2013From:Poudre Valley Air
9704932073 06/20/2013 10:26 #301.P.001/001
FCity of
lirt Cottin5
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 LlghIAA Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
ElVentilation ❑ Water Heater ❑ Water Line ❑ Wood/Pallet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #_ (7' /`� 30 47 Date (dl-zq / 13
For olfite use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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35ZO�
Property Owner Name
Address,
City/State Zip
Phone
sods
s cly CUMIAOSW
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Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here 0 Report
Sales lairmmberLsregtdredbyaYcmixa�
Are you paying with your trust account? 9Yes
13No
Is this a residential or mmen5al project? Residential ❑ Commercial
If residential, is it: Angle Family Detached ❑ Condo/townhcme (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes ❑ No If yes, you may need to contactHistorkPreservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbes&ts assesvnent to subm& with the applicadovx
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 Pt Collins /kense ?
Plumber Mechaniol 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 Name: ��ta�Q G:�Ovm Signature, 3.0 S�Date �'�