HomeMy WebLinkAbout2526 Marshfield Ln - Applications/Air Conditioner - 03/05/2012FROM :NCR FAX NO. :97022999e3 Mar. 06 2011 11:09AM P2/2
City of Planning, Development & Transportation
F6rr}281 N. College Ave P.O. Box 580
t 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). Air Conditioning
❑ Demolition (interior non-structural)❑Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
l7 Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line Q 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.
QO Application #4 ��` ' oL_ Date '_.;0
For otFce use only
Job Site Address (requ/red) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant N3 a Address City/State Zip Phone
Contractor _ Address City/State Zip Phone G.-)'D
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here XReport
Sales tax numberisfwuiredbyall mntracrors. Are you paying with your trust account? QYes ❑ No
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Is this a residential or commercial project? _ Residential ❑ Commercial
If residential, Is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
gMultlfamlly (apartment) 0 Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (expI ' ) _...
Is this building 50 years of age or more? ❑ Yes No If yes, you may need to contact H/storic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpr/or to 1975, you will need an asbestos assessment to submit w/th this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license 0
Electriclact nywj�. 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:
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