HomeMy WebLinkAbout3035 Clemma Ct - Applications/Air Conditioner - 05/22/2013FROM :NCA
FAX NO. :97022999193 May. 22 2012 10:21AM P2i2
Fart Collins
Planningr 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 Lighter ❑ Gas Log
❑ Heating Unit Q Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sower Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line CI WoodlPellet Stove (must be EPA .certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # ' at" Date
For oA`rce use only
Is this a residential ormsllu
mercial project? 12 iesidential ❑ Commercial
If residential, is it:ngle Family Detached ElCondo/townhome (single family attached)
ltifamily (apartment) U Garage
If commerclal, is it: CI Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explai )
Is this building 50 years of age or more? ❑ Yes 7No If yes, you may need to contact Histor/c Preservation
If this is for a demolition permit, what year was the building constructed? if prior to 1975, you will need an asbestos assessment to subm/t with this appileation.
Description of work
*If lawn sprinkler/backtlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license if
Electrician dumber.
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. II know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Nam
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