HomeMy WebLinkAbout4131 Shortleaf St - Applications/Air Conditioner - 08/03/2011Aug 03 2011 12:49PM HP LASERJET FAX
370-663-4097 page 2
City of
Collins
Planning, Qavalopmaint & Transportation
281 N. College Ave P.O. Box 580
Fort Collins,;CO 80524
Phone 970-416-2740 Fax 224-6134
OVER ME -COUNTER PER
This application Is to be used t� apply for the following permits only (i
❑ Oerno icon (interior nonstructural) O Electrical Alteration (not service el
O Heating Unit O Lawn Sprinkleir ❑ Mobile Home replacement O Roofi
O Ventilation O Water Heater 0 Water Line O Wood/Pellet Stove (must
manufacturer).
ills ONLY
ck all that apply). Air Conditioning
ie) O Gas Lghtel O Gas Log
O Sewer Line O Phokw4oltaic
EPA certified, provide make, model and
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #B I0 9 3� Date
nor afte use only
Sob Site Address (m uffed)
value of Cpnobruetion (labor, materials, profit)
<<i �'�at �..F S�. �. t^�l/.� � yo3Zv .DSO• °"
Property Owner Name Address
City/State Zip Phone
She G r1X tot
Applicant Name Address
City/State Zip Phone
tAliotr►c6tFs ONE w.rr_ 42-1 bLrwet,
rove Lowlgw &537 970- S wot
Contractor u_gW Address
City/State Zip Pion
Alloc^J--4s 4 DEwW-A.
AVZ� LovElo-oda; e-& 70ST7 970 61.3 t/uoz
Contractor City of Ft Collins Sales Tax a
Are you paying taxed here or by report? O Here A'Report
Saks W xwitiV r reOWred by a# contrdcrws.
i
Are you paying with your trust account? V Yes ❑ No
Is this a residential or commercial p ? �esident al O Commercial
If residential, is it: P(Sllngle Fam Oetsched O CondoADwnhome (single family attached) O Duplex
O MulOfdmily �apartrnent) O Garage
If commercial, is it: O Bank O apr O Church O Hotel/Motel ❑ Medical office O Office O Retail
O Restaurant 11 O Other (explain)
Is this Wilding 50 years of age or !more? O Yes O No If yw, you may need rro contact Htstovic Awerv~
If this is for a demolition permit t year was the building constructed?
If prior to 1975, y m wl// need an aOesWs assessment to su%7* oft Ma application.
Description of work
*If lawn sprinfilw/baddiow preventer4 must list licensed plumber. If first-time A/C, must fist licensed electlician.
Suboanbaetors: Lim the con any no~ or oty of Ft CoAns &ease r
Beaman- Plumber Methanicas Rooter Other
I hereby acknowledge that I have real) this applkation and state that the above information is complete and correct I agree to
comply with all reQulrements contained herein and city ordinances and state laws regulating building construction. I blow Mat o
pwmk Is net valld until It has belie paid and issued.
Applicant:
print Name: ` -- 5ggnatu►e _.._ Oaw��/