HomeMy WebLinkAbout718 Tyler St - Applications/Air Conditioner - 02/13/2015From:
02/13/2015 10:47 #548 P.001/001
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). lAir Conditioning
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit O 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 ;L-13 Date .)aMs
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
—) T N0o c `'J& -IC, n�--
Property Owner Name Address City/State Zip Phone
,.
Applicant Name Address City/State Zip-
Phone,
Contractor Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # l
Are you paying taxes here or by report? WHere Report
Sales tax number is required by ailcon&actors Are you paying with your trust account? )KYes Gj No
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: mgle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 13 Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you wi// need an asbestos assessment to submit with this application.
Description of work �U i^/9 t- (
*If lawn sprinkler/badQlow 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 o
Electrician 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: C1•
Print Name: ` `ACD\Q �t �� Signature
Date Ql