HomeMy WebLinkAbout5620 Fossil Creek Pkwy - Applications/Air Conditioner - 10/12/2011Fort Collins
planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, Co 80524
Phone 970-416-2740 Fax 224-6134
OVER-ME-COUNTTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not seNlce change) O Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 13 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 # FSH059SI Date l 1 oZ/� l S • 00
For offm use ar
Sob Site Address' 7 ,
Value of Construction (labor, materials, profit)
Property Owner Name _Address
i
City/State Zip Phone
Applicant Name Address
City/State Zip Phone
R) 4jq'Lj -�45503.
Contractor Address
City/State Zlp Phone
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Ez�c gG a s5a-
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Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here AReport
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Are you paying with your trust account? )q Yes I7 No
("_3J 46�
Is this a residential commercial project? Residential ❑ Commercial
If residential, is it. Single Family Detached ❑ Condo/townhome (single family attached) O Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: 0 Bank ❑ Bar O Church ❑ Hotel/Motel E3 Medical office l❑ Office ❑ Retail
O Restaurant 13 Other (explain)
Is this building 5o years of age or more? O Yes Et No lfye yttvm�nc+edh) vntaldN Ae9arvBriCat
If this is for a demolition permit, what year was the building constructed?
if prior to 29n,, y6v a@lneedan asbmft rise Wayltto aeba* W" N►A iari.
Description of work
*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
Subcontractors: List Lf7Caw*wTyrAmme `diyofFtCaWhs//cerse0
Electrician Plumber Mechanical Roofer Other
I hereby admowledge 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: h Sigma Date