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HomeMy WebLinkAbout1142 Cobblestone Ct - Applications/Air Conditioner - 07/03/2012Planning, Revelopment & Transportation Fort of 7.81 N. College Ave P.O. Box 580 4 ort Collins Forte 137 - 1G 8057.4 �-«' Phone 970-41G-2740 Fax 224-6134 QYERmTHE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). iJ Air Conditioning Q Demolition (interior non-structural) ❑ Electrical Alteration (not service change) Ca Gas Lighter 0 Gas Log * Heating Unit CI Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 0 Sewer Line 1:1 Photo -voltaic * Ventilation U Water Heater CI Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Application # I� t I ✓L rir offlce m-w anAr Incomplete applications will not be accepted. Date lob Site Address (regL& r1) Value of Construction (labor, materials, profit) Lq Property Owner Name Address City/State Zip Phone ECcc3 -3_Q56� 0 f Sig 1 Applicant Name Address City/State zip Phone - C b -u5sa- Contractor Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 13 Here YLReport Note,<tax numlxr is' T*V,r-(cdriysno„raacrvrs. Are you paying with your trust account? )q Yes LI No �_s1 Q Ga Is this a residential o co mmerclai project? ),Residential ❑ Commercial If residential, is it: Single Family Detached ❑ Cando/townhome (single family attached) fl Duplex ❑ Muldfamlly (apartment) 0 Garage If commercial, is It: © Bank ❑ Bar El Church 13 Hotel/Motel 0 Medical office ❑ office ❑ Retail a Restaurant ❑ Other (explain) Is this building 50 years of age or more?. Q Yes 13 No !(yes, yrwmayneedto[o► &?aH 9tork/4ery fJW If this is for a demolition permit, what year was the building constructed? dA/.Yir is JRn, )vu railrnc+edan ag)estw ezmwmt toRtt*7 i` IWI) tl)fS4potap gn Description of work *If fawn sprinkler/bockflow preventer, must Ilst licensed plumber. Jf first-time A/C, must list licensed electrician, Swbcontractors: Lh?f/N rx:vrtrr�an�Lp OfyuFf�'i)s/fccse,R tlectNcian t�i_/bJ�( plumber MrrhanlwlJ::jq-7 % � Roofer _ Other ^„ I hereby acknowledge that I have ,mad this application and state thot khe above information Is Complete and correct I agree to comply with all requirements contained herein and city ordinances and state laws regulating building construction, it know that a permit is not valid until it has been paid and Issued. Applicant. Prink Ndme: (' � �LR S I g n a ere _ �4� Date !� /�