HomeMy WebLinkAbout2825 W Stuart St - Applications/Air Conditioner - 07/25/20115-/7 If , Flannmg, uevelopment er i ransportazion
City 0 i 281 N. College Ave P.O. Box 580
Fort Cotlin5 For 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alleration (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 # E 110 � � I le Date %5 =-i /
ForofIce use only V
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address city/State Zp Phone
Applicant Name Address City/State Zip Phone
Contractor Address city/state Zip Phone
Q4 Oe.0 inq �, Aiv aol kSmnkeAi & R 8l li r>s : 'gD525 . �
Contractor City of..FL Collins Sales Tax �
SalesW XMbe-isrequired byall mntradars
//245 g
Are you paying taxes here or by report? ❑ Here XRepoi
Are you paying with your trust account? ❑ Yes A No
11isf
this a residential or commercial project? esiden6al ❑ Commercial
residential, is it: mgle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
commercial, is it: ❑ Bank ❑ Bar ❑ Church .❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to conbcttHlstodc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, ynu will need an asbestos assessment to submit with tlrls application.
Description of
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of ft Collins Acense #
ElectridaA_,,' 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:
PirlhtName: k Signature Date '�S/