HomeMy WebLinkAbout1662 Fossil Creek Pkwy - Applications/Air Conditioner - 05/15/2014Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 8CS24
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-stmi aural) ❑ Sectrical Alteration (not service change) ❑ Gas Ughter ❑ Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voitsic
❑ Ventilation ❑ Water Heater ❑ Water Una ❑ VWWPellet Stove (must be EPA certified, provide make, model and
manufacturer). .
Complete all appildable informati-o�n on the application. Incomplete applications
/will not be accepted.
Application #� I g a 2 3 T (9 Date 5( �51 4f
Por offbe Use onh
Job Site Address utred)
Value.ofCo uction (labor, materials, profit)
If
ProDerty Owner. Name Address CI State Zip Phone �r
o0 /l�lOZ�L�'/� �i! O D
Applicant Name, Address
r4
City/State Zi Pho e
� C C eD.Sd �Z
Contractor Address
city/state ZIP Phone
zr_2' U�� zf
ICEWA-D�COrr�in�rC� ry`
,
Contractor City of Ft..Collins Sales Tax #
Are you paying taxes here or. by report? ❑ Here ❑ Report
Sak+shwnum6gis qa+ b),0#cl M-lo rs,
cam! %aL
Are you paying with your trust account? ❑ Yes 0 No
Is this a residential or mercial project? &Wesidenbal ❑ Commercial
If residential, is it: �ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: C] Bank ❑ Bar ❑ Church ❑ Motel/Motel O Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (")
Is this building 30 years of age or more? O Yes CMo 11`yes, you rr�aYneeb to E�Dntact Historic Presc�rvalloq
If this is for a demolition permit, what year was the building constructed?
1fpHv to IV$, you wi//need an asbestos a&%sywt to subfilt With this "ftat/on.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/c, must list licensed efecMcian.
Subcontractors: V&t the cv??Wy rA" or City of fit C►?NNts license a
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 ordinance3 and -mate laws regulating building construction. I knowthat a
permit Is rK*:val3O until Ic has pald and issued.
Applicant: 7`J�i'y1L'J�Print Name.+ � Sig Dot®,
L.P