HomeMy WebLinkAbout2319 Marshwood Dr - Applications/Air Conditioner - 08/08/2014�F�ort C�oilins
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80521
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to bo used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior nonstructural) ❑ Electrical Alterrotion (not service change) M Gas Ughter 0 Gas Log
13 Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ photo -voltaic
0 Veritilation ❑ Water Heater ❑ Water Une ❑ 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 # `ca� f` f0t5a)3
Pot ofi~ree use on/Y
Date
gob Site Address (teq
Value of Construction (labor, materla is, pront)
Property Owner Name Address City/State Zip phone
oe
Applicant ame , Address
City/state ZI Pho e
C, ro � 2s ;
Contractor Address
City/State Zip Phone
Contractor City. of Ft: Collins Sales Tax ik
Are you paying taxes here or by report? ❑ Here ❑ Report,
sa/esWenu r , uhed6y0/1coatrectors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial projec`? Wesidential ❑ Commercial
If residential, is it: l Single Ft niily Detache ❑ Condo/townhome (single ramlly attached) ❑ Duplex
Cl Multifamlly (apartment) 0 Garage
If commercial, is i: 0 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Offtce C7 Retail
0 Restauznt ❑ Other (explain)
Is this building 50 years of age or more? O Yes ❑ No !r yes, you may need to Cott(>sC(Historic Pr@Se/YBt/orT
if this is for a demolition permtt, what year was the building constructed?
1Fprior to 1975, you will need an crsbes(vs assessment to saGWhff with (his 4/7D✓/Catio1). ---
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
Subcontractora:.1stN2ecaopany,name'crO'tjeOF/tW1ins!lrgps[[.,,QQ
Electrician _ Plumber Machanicalf-_{,i 6 Roofer — _ Other
I hereby acknowledge that I have read this application End 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 valt untJil, It ham been paid and:
' ,/a ,✓
Print Name.,, /� Signallu _ Date