HomeMy WebLinkAbout4202 Center Gate Ct - Applications/Air Conditioner - 06/21/2013From:Poudre Valley Air
9704932073
06/21/2013 09:01 #309 P.002/002
Fiof
t Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box Sao
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,1hhe2e application. Incomplete applications will not be accepted.
Application # �7 Date
oJJ&e Zw only
lob Site Address (required)
Value of Construction (labor, materials, profit)
y20Z C-10&UCk,
G56.00
Property Crooner Name Address
City/State Zip Phone
vethid"
WW, +Cohn; POSZO zzA0- t o" I
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zap Phone
a
Contractor City of Ft. Collins Sales Tax it
Are you paying taxes here or by report? ❑ Here 69 Report
Sales +arnumderamozdmdbya1/cor&aci1om
Are you paying with your trust account? )4Yes [1 No
Is this a residential or m merdal project? KResldential El Commercial
If residential, Is it: ngte Famtly Detached ❑ Condo/townhome (single family attached) ❑Duplex
❑ Multfandly (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? 17 Yes ❑ No Ifyer you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
Ypnor to 1975, you will need an asbestos assessment 4o submk w/yr this appl/otion.
Description of work
"If lawn sprinider/baddtow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List fhe company name or Gly of Collins lkense i
Electridan 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 Name:��CD�Q +� �inm Signatures � - � — Date Z1 ` ��