HomeMy WebLinkAbout900 Rocky Rd - Applications/Air Conditioner - 08/12/2013Fort Collins
Planning, Development rsE Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 97G 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). t�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 # boo L(tv I Date V-102 -13
For ofte use only
lob Site Address (required) Value of Construction (labor, materials, profit)
00 i?o t :k led A 1 $ 3o00- —
Property Owner Name
Address City/State
Zip
Phone
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1
SZ 4ale-1.9
Applicant Name
Address City/State
Zip
Phone
or &42VIL
Contractor Lic #
Address City/State
Zip
Phone
iC � Duc t ALIa3
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44FAA
Ca ZZ;f'324J
Contractor City of Ft. Collins Sates Tax # Are you paying taxes here or by report?
sales far number is required by all mntractws Are you paying with your trust account?
ere ❑'" Report
Yes
Is this a residential or commercial project? )Qtesidential ❑ Commercial
If residential, is it: KSingie 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 50 years of age or more? ❑ Yes )WNO Ifyes, you may need to contadHlSloric Preservation
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you w111 need an asbestos assessment to submit wlb9 this application.
Description of work
*If lawn sprinkler/backflow preventer, must fist licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of f3 Collins license 0
ElecWclan��� 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.
Print Name�7 !� ��411 Signature to ���
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