HomeMy WebLinkAbout3039 Anchor Way - Applications/Air Conditioner - 11/04/2014Nov
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P�11lanning, ®eveloprnent & Transportation
L 11 2014 8 N. College Ave P.O. Box 580
LFort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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This application is to be used to apply for the following permits only (check all that apply). ® Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 13 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 # ?7;�9g5b®7-7—eg' Date
Fnr office use only
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Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip Phone T10
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Applicant Name Address
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Contractor l Address
City//State zip jUS 3 l Phone qto
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Q Here ❑ Report
Are you paying with your trust account? LI Yes ❑ No
sales tax number is required by all contractors
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Is this a residential or commercial project? g Residential ❑ Commercial
If residential, is it: EA Single Family Detached ❑ Condo/townhome (single family attached) ❑ 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/baddlow 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 #
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: C \IJ 2, f C1 W
Print Name: y Signature
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