HomeMy WebLinkAbout3702 Cosmos Ln - Applications/Air Conditioner - 03/05/2012FROM :NCA
Fort Collins
FAX NO. :9702299983 Mar. 06 2011 01:10PM P1/1
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). jJ Air Conditioning
❑ Demolition (interior non-structural) D Electrical Alteration (not service change) 0Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line 17 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 # 0 I �y 10&0 Date
For of ee use only
lob Site Address (requ/red)
3 Z_ Cr�rvu�
Value of Construction (labor, materials, profit)
y I c) O. o o
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State ZIP
Phone
Contractor Address
Clty/State ZIP
Phone C1.1V
f R✓ YK. Q 1,5
L etco�\ its Co SUS2-
Contractor City of Ft. Collins Sales Tax #
Sales raxnumberisrequired byall rnntractois
---
Are you paying taxes here or by report? ❑ Here
Are you paying with your trust account? 0,Yes
XReport
❑ No
Is this a residential or.5irnmerclal project? Jd Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar CI Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑Other (explai) _
Is this building SO years of age or more? ❑ Yes No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year waste building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this applicahbn.
Description of work
*If lawn sprinkler/backFlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Lrst the company name or City of f t Collins license 4
Electrician ✓id fC 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: �j
Print NameYQv�tp►�.C, slq�� Date a S �2