HomeMy WebLinkAbout2527 Marshfield Ln - Applications/Air Conditioner - 05/18/2012FROM :NCR
/Fort of
FAX NO. :9702299983 May. 19 2011 04:20PM P1i1
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). P(Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
17 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
0 Ventilation C] Water Heater 0 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 # V lao 0c I
for office use only
Date _!�. -1- ] Z
Job Site (Walred)
Value of Construction (labor, materials, profit) -
^Address
2 Q
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Property Owner Name Address
City/State Zip
Phone 30 3^
Applicant Name Address
ity/State Zip
Phone .
Contractor Address
City/State Zip
Phone C1_-"f'o
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here I0,Report
Sale+stax number ismquiredbyallmnfmctorc
�p k4 Le 2
Are you paying with your trust account?
KYes ❑ 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) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Rotail
❑ Restaurant ❑ Other (explain
Is this building 50 years of age or more? ❑ Yes qNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was thd building constructed?
Ifpdor to 1975, you w//need an asbestos assessment to submit with this applicalion.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors; Li It
the company name or City of Ft Collins license ,#
EledTician-,W - ,__i.Qi2Plumber---_ 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 b—I A Z
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