HomeMy WebLinkAbout216 Tulane Dr - Applications/Air Conditioner - 05/31/2012 (2)FROM :NCA
of
Flirt Collins
FAX NO. :9702299983 Jun. 01 2011 03:37PM P4/4
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). 1 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) I]Gas Lighter 0 Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement D Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater El Water Line ❑ Wood/Pellet Stove (must be EPA certified, piovide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 1 O�A Date Z
For offce use only 1 —
Job Site Address (required)
Value of Construction (labor, materials, profit)
Name Address City/State Zip Phone
Address Gty/State ZIP Phone
Contractor Address City/State Zip Phone c(
✓tl�.o✓ �oio��A;v,1r�c.. Qi2 5�rzcic,Lt �011'tx2 3
Contractor City of Ft. Collins Sales Tax l/ Are you paying taxes here or by report? ❑ Here IXReport
M/P-Ttax number isrequlredby.amavjtracnrt Are you paying with your trust account? VYes ❑ No
z lv Lip 2 .
Is this a residential or c9mmercial project? A Residential ❑ Commercial
If residential, is It: Z Single Family detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church CI Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is thls building 50 years of age or more? El Yes Xi o if yos, you may need 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 electriclan.
Subcontractws: Li the company nann* or City of h7 Collins license 0 —
r
Electrldan ✓.p 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 Nam
Date.— ,