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HomeMy WebLinkAbout3581 Pike Cir - Applications/Air Conditioner - 05/14/2012FROM :NCR FAX NO. :9702299983 May. 15 2011 01:39PM P4i4 Fort Collins 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). Air Conditioning Di Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Ligh# ❑ 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. Application # �aD W yX For office use only Date N:J Z gob Site Address (tequired) �� I<F_ C I R Value of Construction (labor, materials, profit) CP C c0•oc Property Owner Name Address City/State Zip Phone Applicant Name Address City/State ZIP Phone Contractor Address City/State Zip Phone �1 k)ov+kPvnLd0yadn&,�,Nn(-, % 2- e. co l 5L ax-1, , Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here I(Report Sales taynumberlsrequired byall contractors. S. tag LO 2- Are you paying with your trust account? VYes ❑ No Is this a residential or mmercial project? IXResidential ❑ Commercial If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex T Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church CI Hotel/Motel ❑ Medical office ❑ Office ❑ Retail C] Restaurant ❑ Other (explain) _ Is this building 50 years of age or more? ©Yes PrNo If yes, you may need to contact Historic )7teservation If this is for a demolition permit, what year was the building constructed? Ifprlor to 1975, you will need an asbestos assessment to submit with this application. Description of work *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Lilt the company name or city of Ft Collins Acense # Electrician ✓� oett(Rlumber _ Mpchanical 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 Sl �kf L—