HomeMy WebLinkAbout627 Sedgwick Dr - Applications/Air Conditioner - 09/30/2014From:
09/30/2014 06:59 0048 P.002/003
I-tS095
arof
t 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). K1ir 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 ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complet��llll ap ucaale i f rmption-on the application. Incomplete applications will not be accepted.
Applicatt'O'6i # "�i i'�_ i � lJ Date
- 913DI[q
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
}
05. y�Z
Property Owner Nan9e Address
City/State Zip Phone
jr co 8V SQ 5 31-1 ya(s
Applicant ame Addres
city/State Zip Phone
Contractor Address
City/State Zip Phone
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? OHefe Report
Saes tar number is required by a//contactors.
Are you paying with your trust account? XYes tI No
Is this a residential or commercial project? k Residential ❑ Commercial
If residential, is it: ASingle 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?
ff pilor to 1975, you will need an asbestos assessment to submit with this app/lcadon.
Description of work Unl (,e., 6 1 C'
�•-P-"-ti=vudLrtuow prevencer, 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
GPTai
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: [� f1 r� `tom
Print Name: \�CD�P h:� n�.t.� Signature J_1L! ��,g, �\ , . �.._ Date (7