HomeMy WebLinkAbout1509 Ambrosia Ct - Applications/Air Conditioner - 11/06/2014City of Planning, Development & Transportation
p p 281 N. College Ave P.O. Box 580
®i�t C®1�t ns NOY ` 1208i Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMTS ONLY
This application is to be used to apply for the following permits only (check all that apply). rt7"Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
'gHeating 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 # T-7)1dF50r) ?--7 Date I `�
For office use only A --I ?—I
Job Site Address (required)
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Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip 9 o5 2 c4, Phone 6(-1
Applicant Name '
Address
City/State Zip Phone q 7 0
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Contractor
Address
City/State Zip ,'305 3 l Phone c 1,0
Contractor City of Ft. Collins Sales Tax
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Are you paying taxes here or by report? 0 Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? 19 Yes ❑ No
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Is this a residential or commercial project? fa Residential ❑ Commercial
If residential, is it: � Single Family Detached ❑ Condo/townhome (single family attached) El Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ 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?
Ifprior 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: List the company name or City of Ft Collins license 9
Electrician Plumber Mechanical Roofer
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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. E know that a
permit is not valid until it has been paid and issued.
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Applicant: D �J4 K I (I i
Print Name: t i Signature f� (., <V i�a _.� Date I t I 1