HomeMy WebLinkAbout2155 Orchard Pl - Applications/Air Conditioner - 07/14/2014City of
Planning, Development & Transportation,
281 N. Ccllece Ave P.O. Box 580
For Collins, CO 80524 !1
Phone 970-416-2740 Fax 224-6134 �'t U V
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that applyl. ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Loa
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑.Sewer Line ❑ Photo -voltaic
Cl Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stave (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # d )�3�� �J _ Date
For office use only
Is this a residential or commercial projedtz PAesidential El Commercial
If residential, Is it: ❑. Single Family Detached ❑ Cando/townhome (single family attached) .❑ Duplex
,Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hatel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or mare? ❑ Yes ❑ No Ifyes, you may need to coatactHistoricPraservadon
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflaw preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Gst the mmpany name or City of R Collins license #
Electricld �th 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:
Print Name: Signature Data
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