HomeMy WebLinkAbout819 Quail Run - Applications/Air Conditioner - 04/18/2012Apr 18 12 12:49p Air Masters LLC
9705322006 p.1
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, GO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply forthe following permits only (check all that apply). XAir Conditioning
❑ Demolition (interior non-structura0 ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ 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. A
Application # R. I a 0a,1 0, 1�
For olfxe use only
Date /61��/2Qf
Job Site Add requfred)
Value of Construction (labor, materials, profit)
19.
Pro rty Owner Name Address City/State
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Zip
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Phone
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Applicant Name Address
City/ State
Zip
Phone
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Contractor Address
City/state
Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? X Here
❑ Report
Sales tax numberesrequlredbyalimnimdors.
Are you paying with your bust account. ❑ Yes
No
Is this a residential or mercial project? Z Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes )4No If yes, you may need to contvct Historic Preservatfon
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you M11 need an asbestos as3esrnent to submit with Nris appficahon.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Me company name or Qty of Ft Co/Gns license # Electrician Plumber Mechanical ./ + (Jq
Roofer Other
I hereby advwwledge 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.
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Applicant:
Print Name:a�jt�� Signature Date Ill L—
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