HomeMy WebLinkAbout720 Arbor Ave - Applications/Air Conditioner - 08/23/2011Fort of
/10'�
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). Oir 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 O 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 # 9 1 I(� . 5�1 Date 8 `�3�\1
For offlb° ise onty
lob Site Address (required)
a
Value of Construction (labor, materials, profit)
BS
Property Owner Name Address
City/State Zip
Phone
u- 8
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
sNeFtixnuftffisrequreaayall mntrarrws:
Are you paying taxes here or by report? ❑ Here
Are you paying with your trust account? $(Yes
0 Report
p No
Is this a residential or commercial project? Wesidential O Commercial
If residential; is it: qfSlngle Family Detached O Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church O Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes O No Ifyes, you may need to contact Hlsror/c Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you w///.need an asbestos assessment to submit with this application.
Description of
*If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or lily of ft Collins license ,
Electrician 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: /1
Print Name:ACrDX C %0-\\Ty% Signature,,,,N.4 Date
1.00/1.00'd b604 L9:60 I.IO2/£2/80 ELOZESVOL6 JIV AaTTPA a.ipn0d:w0JJ