HomeMy WebLinkAbout1753 Concord Dr - Applications/Air Conditioner - 08/20/2012FROM :NCA FAX NO. :9702299983 Aug. 21 2011 05:11PM P4/6
Planning, Development & Transportation
City of 281 N, College Ave P.O. Box 580
6r` Cottins Fork Collins, CO 80524
f✓^r 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). Air Conditioning
El Demolition (interior non-structural) EI Electrical Alteration (not service change) C] Gas Lighte ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line 13 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 applications, Incomplete applications will not be accepted.
Application # 2 0 6-73 Date
For office use only
Job Site Address (required) ^- Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
TQJI
qn
Applicant Name Address city/State Zip Phone
Contractor — - Address l--City/State Zip Phone1
,\YYli< ''1 � S i 1, & co S-IfsL4-
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here XReport
Salestaxnumberisrequiredbyall tmtmctors Are you paying with your trust account? I Yes ❑ NO
Is this a residential or c mmercial project? /O Residential El Commercial
If residential, is It: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑Liar ❑ Church ❑ Hotel/Motel CI Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain) ... _ _..... _...._
Is this building 50 years of age or more? 13 Yes .01N0 If yes, you may need to contact Historic, Preservation
If this Is for a demolition permit, what year was the building constructed?
11 prior to 19i5, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinklerlbackflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of R Collins Aciense #
Electrldan_�Lk� Plumber _. Mechanical Roofer ^ T 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 �.�✓� SiSniftuDate_