HomeMy WebLinkAbout3517 Fieldstone Dr - Applications/Air Conditioner - 07/01/2013FROM :NCR
FAX NO. :9702299983 Jul. 01 2012 05:04PM P2/5
Fort Coliin5
Planning, Development & Transportation
281 N. College Ave P,O. Box Sao
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).Air Conditioning
El Demolition (interior non-structural) 4 Electrical Alteration (not service change) ❑ Gas LighterEl Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line Q 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 # ' _3033y Date
-
For otflce use only
Job Site Address (req fired)
Value of Constructlon (labor, materials, profit)
C� .. .
a
Property Owner Name Address
City/State M Zip
P
Phone
V" Z
Appli nt Name Address
city/state Zip
Phone
Contractor Address
City/State Zip
Phone cl—tD
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etcot\` co S-DSL4
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? 0 Here
IXReport
Sales lax number IsregWredbyall contracts;
Are you paying with your trust account? KYes
El No
Is this a residential or c mmerdal project? oRfPesidential 0 Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church 0 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 1ITNo rfyes, you may need to contact H/storic Preservation
If this is for a demolition permit, what year was the building constructed? _
Ifpnor to 1975, you w1/1 need an asbestos assessment to submit with this applicat/on.
Description of work
*If lawn sprinkler/backnow 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 0
Electrician 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.
Applicant:
Print Nam
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