HomeMy WebLinkAbout1533 Purple Sage Ct - Applications/Air Conditioner - 07/17/2014d'�- td 7//i�/�
City of Planning, Development & Transportation
C y 281 N. College Ave P.O. BoX• 580
6 _! rt 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
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ 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 # 151`foLl®ZC) Date
For offce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
1533 k6l el,'Uc 54L
Cr
3 3 00 "o
Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phone
CHOS Burr-5 a3F7
ST-,
L.o u&,et_ GU 3c63
6 W - q7 93
Contractor
Address
City/State Zip
Phone
La - T-Ax.
6j. gy
ST. LoU / > > Yo!537
0- 63- qc7q3
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contracroy)q) r 1
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? fiX Residential ❑ Commercial
If residential, is it: kSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ],No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with 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 #
Electrician �5� Plumber Mechanical A 1731 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. A7 %
Applicant:
Print Name:Signature
Date 7 /7