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HomeMy WebLinkAbout415 Smith St - Applications/Air Conditioner - 09/11/2014From: 09/11/2014 10:02 *313 P.004/006 city of 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), it Conditioning © Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas LighterT3Gas Log 0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line Cl Photo -voltaic ❑ Ventilation ❑ Water Heater 0 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 #. For office use only Date _ Q.\Ajd Job Site Address (required) Value of Construction (labor, materials, profit) '1\S S�y Property Owner Name Address City/State Zip Phone t 1 -1 Applicant'Name Address City/State Zip Phone Contractor Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # Sales Are you paying taxes here or by report? WrHere *Report tax number &,equiredbyal/mnbacrors Are you paying with your trust account? )KYes El No Is this a residential or commercial project? Wesidential ❑ Commercial If residential, Is it: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex Q Multifamily (apartment) ❑ Garage If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building So years of age or more? ❑ Yes 0 No If yes, you may need to contact Historicpreseivabon If this Is for a demolition permit, what year was the building constructed? rfprior to 1975, you w1/l need an asbestos assessment to submit with this application. Description of work *If lawn sprinkler/bacKow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or City of Ft Collins license 0 Electrician mar ft�`RS 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: (�\�\�.D/► Print Name: \ �Q , {�-w�Q_�� Signature . Ar.n Date c'