HomeMy WebLinkAbout3461 Fieldstone Dr - Applications/Air Conditioner - 08/25/201409-09-14;10;16AM;
;970-484-4448
# 4/ 8
of
Fort Collins
Planningr Development &Transportation
281 N. College Ave P.Q. 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).YAir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) '❑ Gas Llghte Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Q Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water line Q 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 # 'gl+-VgZP� Date.
ForoA9ce use only
Sob Site Addr (requred)
Value of Construction (labor, materials, rofit
Properly Owner Name
Address City/State Zip
Phone
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Applicant Nam
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Address city/State Zip
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phone
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contractor
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Address City/State Zip
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Phone
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Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report?
❑ Here Report
sans taxnumber�� qu�Obyalleono-aero/s,
Are you paying with your trust account?
).Yes ❑ No
Is this a residential or commercial project? Alkesidential ❑ 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 ❑ .Retell
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact HistorkFreservatlon
If this is for a demolition permit, what year was the building constructed?
If prlorto 1975, you will neCV an asbestos assessment to subm/t with this appl/ca8'on.
Description of work
- C j
*If lawn sprinider/backnow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name orCRyofFtColl/nslicense#
Eledridan Plumber Median)®I__ _ 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: ��' •,�5 �ll
Print Name: i I n Signaturo Date ``ii