HomeMy WebLinkAbout4560 Larkbunting Dr - Applications/Air Conditioner - 07/22/2013FROM :NCR
Fart Collins
FAX NO. :9702299983 Jul. 22 2012 11:10AM P2/6
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). VAir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 0 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 # 5 ( $0 57q0
or office use only
Date 3
Sob site Address (required) �^
Value of Construction (labor, materials, profit)
Wign L ,r Y,
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Property Owner Name Address
City/State Zip
Phone
AL
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47f
Applicant Name Address
City tate Zip
Phone
Contractor Address
Clty/State Zip
Phone CI"'M
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
&,Report
Sales tax numaerisrequlred by all contractors.
Are you paying with your trust account? %,Yes
❑ No
12 1p 9' I,o 2—
Is this a residential or c9mmerclal project? .ICJ Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (singlo family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church C] Hotel/Motel ❑ Medical office ❑ Office Q Retail
A Restaurant ❑ Other (expla )
Is this building 50 years of age or more? O Yes No If yes, you may need to contact Hlswric Preseruarlon
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/back-flow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors, Ust the company name or City of Ft Collins license 0
ElecnlclaPlumber Methanlcal Rooker 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 isoued.
Applicant:
Print Nam
Date