HomeMy WebLinkAbout7245 Fort Morgan Dr - Applications/Air Conditioner - 12/02/2014Resendll-04-14;10:14AM; ;970-484-4448 # 18/ 20
Fart Collins
Planning, Development & Transportation
281 N. College Ave P,O. Box s80
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVERmTHE-COUNTER PERMITS ONLY`,
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 Lightef ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement O 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 iInformation on the application. Incomplete applications will not be accepted, t t
Application # it? 1 4 IA I Date
for office use only
Job Site Add uaed)
Value of Construction (labor, materials, profit) D,6
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ProogOwner Name Address
h�a.
City/State Zip
Phone
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A piicant Nam Address
City/State Zip
Phone
ri 'At
ly AO 6. L. J M
YA(l
ntractor Address
city/state ZiP
Phone
filk,i /D i
$0: a
gy elSIVI
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here
;keport
sees cWflum erA Mdbyell cnno-acrorx
Are you paying with your trust account?
.Yes
❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: Ingle Family Detach ❑ Condo/townhome (single family attached) ❑ Duplex
rfi0 Multifamily (apartment) ❑ Garage
If commercial, is it: M Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office O Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? O Yes I7 No Ifyas, you may need to contact Nlstor/CPreservatiOn
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you w/ll neft an asbestos assessment to subm/t wltb this dpplicadon.
Description of work
*If lawn sprinkler/backilow preventer, must list licensed plumber. If Flrst-time NC
Subcontracborsr Llst the company name or CI'ty of Pt Cbll/ns license 0
SoWdan Plumber. Medianl®I 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
Print Name: iTJI n
Date ��_
06