HomeMy WebLinkAbout749 Marigold Ln - Applications/Air Conditioner - 08/18/2011Fort Collin
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). KD1ir 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 the application. Incomplete applications will not be accepted.
Application # f In SCP�i�- Date 8\1�
leofce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
® Report
Sales rarnumber&iWwhedbya#coaftcrors.
Are you paying with your trust account? XYes
tiNo
Is this a residential or commercial project? Mesidential ❑ Commercial
If residential; Is it: Ingle Family Detached ❑ Condo/townhome (single family attached) . ❑ Duplex
❑ ultifamily (apartment) ❑ Garage
If commercial, is It: 17 Bank 0 Bar E3 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ClYes t7 No 1f yes, you may need In contact Hiswr/c Preservation
If this Is for a demolition permit, what year was the building constructed?
Ypnor to 1975, you wi//.need an asbestos assessment to submit wJth this application.
Description of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty ofRCollins license 0
Sectrician 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: ��t.D�Q _ GA)ftY. Signature," &111 -- ��— Date
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