HomeMy WebLinkAbout1832 Orchard Pl - Applications/Air Conditioner - 07/25/2013FROM :NCA
FAX NO. :9702299993 Jul. 26 2012 11:0GAM P1i4
Fort Collins
Planning, Development & Transportation
281 N. College Ave P,O. Box 580
Fort Collins, CO 80524
Phone 970-41.6-2740 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 ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
0 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 # � ma3 j V Date � " ZS J
for ofte use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone (,pOj
Applicant Name Address City/state ZIP Phone
Contractor Address city/State Zip Phone q -Vo
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Contractor City of Ft. Collins sales Tax # Are you paying taxes here or by report? ❑ Here IIXReport
s�IP.stax numberismquiedbyairmnaactryv. Are you paying with your trust account? %,Yes ❑ No
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Is this a residential or co mercial project? kfResidential ❑ Commercial
If residential, is it: or
Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank 11 Bar Q Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes XNo if yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?.
If pirlor to 1975, you will need an asbestos assessment to subm/t wid i this applicadon.
Description of work
*If lawn sprinkler/backfiow 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
.Electrician Plumber— Mechanical RWer 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.
ApplicantPrintG LQN 7 Date a�, 7