HomeMy WebLinkAbout1344 Village Park Ct - Applications/Air Conditioner - 05/31/2013FROM :NCA
FAX NO. :9702299983 May. 31 2012 02:58PM P3i4
City Planning, development & Transportation
:/ 281 N. College Ave P.O. Box 580 Fart Coltins Fort Collins, CO 80524 /G
Phone 970-416-2740 Fax 224-6134 ` -I
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
El Heating Unit 0 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 the application. Incomplete applications will not be accepted.
Application # 13` JO;Z717%
rot office use only
Date
Sob Site Address (required)
Value of Construction (labor, materials, profit)
P operty Owner Name. U
Address
CI /state Zip
Phone
l
1
✓t L./
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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
I (Report
salestax number isrquiredbyall mntuctors
Are you paying with your trust account? VYes
❑ No
Is this a residential or co mercial project? Residential Q Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant Q Other (explain)
Is this building 50 years of age or more? O Yes ➢iNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if prior to 1.975, you will need an asbestos assessment to submit with this application.
Descriptlon of work
*If lawn sprinkler/badcAow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: Llst the company name or Co of Ft Collins license 0
Electrician_ Piumber 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.
Applicants
Print Nami
Date