HomeMy WebLinkAbout200 S Grant Ave - Applications/Air Conditioner - 06/30/201407-01-14;03:26PM; , ;970-484-4448 # 8/ 18
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110F6rt Collins
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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 ��•�1
This application is to be used to apply for the following permits only (check all that apply). Jr Conditioning
❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Ughr Gas Log
❑ Heating Unit ❑ Lawn Sprinkler M Mobile Home replacement ❑ Roofing O Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodiPallet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted,
Application # BQ L+*0350b Date
for office use only
Job Site Address 6 uired)
Value of Construction (labor, materials, profit) OO
s
Property Owner Na Address
City/State ZIP
Phone
-! 71
Applicant Nam Address
Sherri 10h9-L-)MK
City/State Zip
W4 P& a 90S
Phone
q7140• S 9!1
:Xriitg
Contractor Address
e l !o s. ;
Clty/State Zip
P& Go Fo5a
Phone
y911_ y9 1
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report?
El Here ;keport
saleseaxnumber%FOr u`6Cfbyanwnraaors.
Are you paying with your trust account?
Yes ❑ No
Is this a residential or c mmercial project? residential ❑ Commercial
If residential, is it: Ingle Family Deta ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retall
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? i l Yes 17 No If yes, you may need to contact HIStorlePrawiWdon
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit wide this applic-adon.
Description of work
*If lawn sprinkler/backhow preventer, must list licensed plumber. If first time A/C, must list licensed electrician.
Subcontractors: UstMacompanynamearCRyofftColllnslicense 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 conMetlon. I know that a
permit is not valid until it has been paid and Issued.
Applicant:
Print Name:s6l�lI' n Signature
Date -'�/ Ll