HomeMy WebLinkAbout3272 Silverthorne Dr - Applications/Air Conditioner - 06/29/2012City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins 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). "ir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo-voftaic
❑ 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.
Application # a I old 3cw0
For office, use only
Date La2a\`2
Sob Site Address &Wulred)
Value of Construction (labor, materials, profit)
Property Owner Name Address
OW/State Zap
phone
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
�
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
10 Report
Sales tax number is required by a#Mn8aCx
Are you paying with your trust account? l4Yes
Q No
Is this a residential or commercial project? q tesidential ❑ Commercial
If residential; Is it: Oingle Family Detached O Condo/townhome (single family attached) ❑ Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar 13 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes I7 No If yes you n2ay need to contact H40ork Preservation
If this Is for a demolition permit; what year was the building constructed?
Ifprior to 1975, you wi/I need an asbestos assessment to submit with this application.
Description of
' If lawn spnnider/bacldlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& Me company name or Gty of Ft Collins Ikense #
Elecbidan 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 NameSNILQ�e Signature Date
1.00/1.00'd 0911 EZ:80 ZIOZ/8Z/90 ELOZE113TrOL6 a?U AaTTPA a.lpn0d:w0JA