HomeMy WebLinkAbout3109 Bryce Dr - Applications/Air Conditioner - 05/14/2014From:
05/14/2014 07:29 - 0067�P.001/002
City Of Planning, Development & Transportation
• 281 N. College Ave P.O. Box 580
F6rt Collins 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). �1ir Conditioning
0 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 #_[?� 1 4-10-7 _ ( d —j - Date SU\X'4
For ofte use only
Job Site Address (required) Value of Construction (labor, materials, profit)
3\0�► 7�6c a Or S��aa\g
Property Owner Name Address City/State Zip Phone
Applicant Name — Address City/State /State
- tY Zip ..Phone
Contractor Address City/Zip
State
. k% A P Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? II rHere .Report
Sales tax numbw & required by all con&actors Are you paying with your trust account? X Yes p No
Is this a residential or commercial project? 6gFesidentlal ❑Commercial
If residential, is it: N�5ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage 1
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office O Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ONO If yes, you may need to contact Historic preservation
If this Is for a demolition permit, what year was the building constructed?
tfpr/or to 1975, you will need an asbestos assessment to submit with this app/1cadon.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty offt Collins /Icense #
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 Name: Lt Ne +MG�� SignatureDate