HomeMy WebLinkAbout315 Strasburg Dr - Applications/Air Conditioner - 07/16/2013Planning, Development & Transportation
Clt)/}Of 281 N. College Ave P.O. Box 580
FOrI� 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)v'15�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.
Application # /-:�)o�a
For office use only
Incomplete applications will not be accepted.
Date 7 —4-13
Job Site Address (required) Value of Construction (labor, materials, profit)
31 S S�a0Sb 25-00
Property Owner Name
Address
City/State Zip
Phone
"zvvl
is
� Cali t vi S'ZS
970 qQz
Applicant Name
Address
City/State Zip
Phone
T°fDe L02 (Cr
f 4+6I Cc> 52 01 970 23) 3z/
Contractor Lic #
Address
City/State Zip
Phone
Aire Sero 4 -1 60q
3 - Delozl-
-fev awrh BogZN
ft 2,92-7ZZ0
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
❑ Here Report
ales tax number Isrequimdbyall contactors.
S
Are you paying with your trust account?
❑ Yes 7110
3i2CLI
Is this a residential or commercial project? ,,;EOesidenual ❑ Commercial
If residential, is it: .Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO 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?
Ifpnor to 1975, you MY need an asbestos assessment to submit with this application.
Description of work
*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 #
Electridan (fvc n/ QWc C'C Plumber Mechankal AIrCS& 1/ 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:9Y1'l2S V G Signature ate r to ^ )