HomeMy WebLinkAbout2118 Rollingwood Dr - Applications/Air Conditioner - 06/24/2013Frow Poudre Valley Air 9704932073 06/24/2013 13:41 #316 P.001/001
FpCiof
ort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 8DS24
Phone 970-416-2740 Fax 224-6134
,
This application is to be used to apply for the following permits only (check all that apply). dvAir 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
CIVentilation 13Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicableeiinffo�rm2ation on the application. Incomplete applications will not be accepted.
Application # Cal Jo 1, 5-1th
For office use only
Date
)ob Site Address (required)
Value of Construction (labor, materials, profit)
•aVl-
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here 5d Report
Sales Lax number isrmuredbyall cvntractom
Are you paying with your trust account?
XYes 13 No
Is this a residential or commercial project? sidential ❑ Commercial
If residential, is it:ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar ❑ Church 13 Hotel/Motel 13 Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact Historic presen2tion
If this is for a demolition permit, what year was the building constructed?
Tf prior to 1975, yvu wffl.need an asbestos assessment to submit w/th this app/lcabon,
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors:List Mecompany name orG'tyofftCollins licerRse 0
Electrician Plumber Mechanical RooferOther
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:\CA�Q %t��V�F% SignatureDate