HomeMy WebLinkAbout2727 Amber Waves Ln - Applications/Air Conditioner - 08/15/2011AUG-1672011 14:51 From:Allen Service 970 484 4448 To:92246134 Paee:2/8
City ofFort J
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 uses
O Oemolition (interior non-stru
❑ Heating Unit ❑ Lawn Sprir
❑ Ventilation O Water Heater
manufacturer).
Complete all applicable infor
to apply for the following permits only (check all that apply), Air Conditioning
Ural) 0 Electrical Alteration (not Service change) Q Gas Lighter 0 Gas Log
ler 0 Mobile Home replacement p Roofing C] Sewer Line ❑ Photo -voltaic
:1 Water Line . ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
Application # B 11 D
For office use only
on the application. Incomplete applications will not be accepted.
Date 8- /5-11
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address City/State Zip
Phone
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Applicant Name
Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
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Contractor City of FL Collins Sal s Tax #
Are you paying taxes here or by report?
❑ Here Report
Sales by number is required by all aon actors.
Are you payl ng with your trust account?
9 Yes O No
Is this a residential or commercial project? gVesIdendal ❑ Commercial
If residential, is it: Single Fa rily Detacl d ❑ Condo/townhorne (single family attached) ElDuplex
❑ Muldfamil (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel O Medical office ❑ office ❑ Retail
❑ Restaurar t ❑ Other (explain)
Is this building 50 years of age �r more? ❑ Yes CINo If yes, you may need to contact Historic Preservadon
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you will need an asbestos assessmenr to submit with Phis application,
Description of work
*If lawn sprinkler/backflow prevent r, must list licensed plumber. if first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license 0
Electrician ____ Plumbe, 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. _ Y_ Signatur• Date _