HomeMy WebLinkAbout5403 Roma Valley Ct - Applications/Air Conditioner - 07/21/2014FROM :NCA
FAX NO. :9702299983 Jul. 21 2014 10:29AM P5/5
Fort Collins
Planning, Development 8L Transportation
281 N, College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22"134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Q Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement d Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Cmmnlate all aonlicable information on the application. incomplete applications will not be accepted,
Date
Application #
For 0h4re use OnlY
Is this a residential or commercial project? VResidentlal ❑ Commercial
If residential, Is It: gSlngle Family Detached O Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank p Bar ❑ Church ❑ Hotel/Motel Gl Medical office ❑ Office ❑ Retail
❑ Restaurant ' ❑ Other (explain)
Is thls building 50 years of age or more? C l Yes )dNo If yes, 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 coil/ need an asbestos assessment to submit with this applrcadon,
Description of work
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or CifY of Ft Collins license
Eleciridan _ 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.