HomeMy WebLinkAbout2739 Denver Dr - Applications/Air Conditioner - 06/16/2014FROM :NCR
FAX NO. :9702299983 Jun. 16 2014 08:56AM P2/5
X,F„rt`ollins
Planning, Development&Transportation
281 N. College Ave P.O. Box 580
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
❑ Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voltelo
❑ 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. L41
Application # 514oub(4 Date (P--
For office ase only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
Clty/State Zip Phone
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Applicant Name Address
City/State Zip Phone
Contractor Address
City/state FA-CoUlvtczip Phone'f-,Yb
pt'01 V Lyadn Ak I Yhc. 21 A& GO W> 2-4 ;43M
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ere ❑ Report
salesraxtiamberisrequilvdbyalleonftao s
Are you paying with your trust account? es ❑ No
Is this a residential or c merdal project? a Residential ❑ Commercial
If residential, is it: AD Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Muitifamlly (apartment) Q 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 �,+t No If yes, you may need to contact Historic Pieservadon
If this is for a demolition permit, what year was tMe building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this appllicabon.
Description of work
*If lawn sprinkier/backfiow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors! List the dompany name or city of Pt 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: i / ( 1 i � �
Print Name if V�tR�ILLSig Date _ �`L t O"b C__