HomeMy WebLinkAbout301 E Stuart St - Applications/Air Conditioner - 06/26/2013Cityof Planning, Development & Transportation
281 N. College Ave P.O. Box 580
CO !_ rl. Collins 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).X Air 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 # 8IvZOv170 Date Z�
For oliice use only
Sob Site Address (requi ed) Value of Construction (labor, materials, profit)
301 - �-%o �- �. 39 �7220, oa
Property Owner ame j
Address `1 City/State
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Zip Phone
9d52.5-
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Applicant Name
Address City/State
Zip
Phone
Contractor is #
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Address City/State
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Zip
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Phone
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Contractor City of Ft. Collins Sales Tax
# Are you paying taxes here or by report?
❑ Here ❑ Report
sales tax number is required by all contactors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential commercial
If residential, is it: ❑ Single Family Detached ❑Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar 49fChurch ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
i ✓'
1,04
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician 99LKOA_ 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: ( v rC e O+bl{
Date d _ 2 6_ /.Y