HomeMy WebLinkAbout6914 Egyptian Ct - Applications/Air Conditioner - 08/22/2011Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
rtCQttjns 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). O Air Conditioning
❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) 13 Gas Lighter O Gas Log
❑ Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement O Roofing 13 Sewer Line O Photo -voltaic
• Ventilation 0 Water Heater ❑ Water Line U Wood/Pallet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # B I 1 0 b5c � Date g 1! I I S- Q0
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Job Site Address (n3A& g
Value Construction (labor, materials, profit)
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Property Owner Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
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Contractor Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? O Here Report
bades
Are you paying with your trust account?)Yes 0 No
L31 q 0 a
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is It; 0 Single Family Detached O Condo/townhome (single family attached) O Duplex
❑ Multifamily (apartment) 13 Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 13 Office 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? Q Yes 0 No IlFy s, ydrrmwdy»eeddp[a7ni�CtN ntR> iar1
If this is for a demolition permit, what year was the building constructed?
Ifpni7r a> i975, rev wa61 r�+d arr a l7Etrrt tt?svbnlei a'f� Oh1G �.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician,
Subcontractors: (isi(Iarynam�drCRycRCaIPirS gcase;a'
Electrldan Plumber MechanicalHI-*,115q 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:
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