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HomeMy WebLinkAbout3253 Sagewater Ct - Applications/Air Conditioner - 08/27/2014F I City of Planning, Developmerit & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-604 OVER-THE-COUNTER PORMITS ONLY � This application is to be used to apply for the following permits only (check all that apply)- CI Air Conditioning ❑ Demolition (interior non-structural) © Electrical Alteration (not servibe change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ ho r ofing ❑ Sewer Line 0 Photo -voltaic W ❑ Ventilation ❑ater 1 i to ❑ vvat I.i ea er ne ❑ vvoodlPetiet Stove ( ust be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application # �� 0�� �8 Date d���P U fbr Q#kv asp only lob Site Address Cir'guitw1 Owner 1:1FYXze?'� ' Contractor r7/7 /71 Contractor City, of Ft..Colllns Sales Tax # sales tak numb i ulred by all m7lrarin+s, — �Cr� Value of Construction (la r, materials, profit) Address City/state 7.Ip Phone rddreess City/State ZI Pho e Address City/State zip Phone Are you paying taxes here or.by report? ❑ Here ❑ Report Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or commercial project? ❑ Residential ❑ Commercial If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Carage If commercial, Is It:. CI Bank ❑ Bar ❑ Church d Hotel/Motel p Medical orMce ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 54 years of age or morn? ❑Yes to .No yes, POO MR)/ need to t'ontacY lylstorif Ptserietion If this is for a 'demolition permit, what year was the building constructed? 9PHor to 19>5; you Will ac&d an asbestos QsSess/nont to su&iplt ey/tl;t this application. . Description of work.. *If lawn sprinklcr/bacl(now preventrT.' must list Iicensey d plumber. IF far t thee A/C, must list licensed electrician. Subcontractors, (ist, tqe cnn, rp.3ny name a• Cyty Off Cb///ns license,�/� s� Cledrician_ �,-_ Plumber___, _ Mechanical///,Ja Roofer _ •` Other I hereby acknowledge that F have read this application and state that the above information is complete and correct. I agree to comply with all rEgUirements contained herein and city ordinances and state laws regulating building construction. imowihata permit is not valid until it hays been paid and issued. Applicant' �,/ - ._ Print Name..--, r �i/�,2-�' ' _ —. —_�._. G'signatu % pate "7 _ — —..�