HomeMy WebLinkAbout120 W Laurel St - Applications/Air Conditioner - 08/19/2014From
08/19/2014 04:02 #268 P.001/002
Fort of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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). Q Air Conditioning
❑ Demolition (interior non-structural) O Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line O 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.
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Application # e) ��o'-7 19 V Date
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
of
Pr perryt TM Owner Name Address
V%r City/State Zip Phone
Applicant Name Address City/State
Zip Phone
Contractor Address City/State Zip
.. P Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? WHere Report Sales tax number rs rmgarred by all Are you paying with your trust account? Ayes CI No
Is this a residential or commercial project? b Residential ❑ Commercial
If residential, Is it: ❑ Single Family Detached 13 Condo/townhome (single family attached) O Duplex
❑ Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank O Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes ❑ No If yes, you may need to contact yistor. preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, yvu 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: LAt the company name or City of Collins license #
Electrician%k'QL� 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: VN� Signature . �,,.
rL— Date 1�