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HomeMy WebLinkAbout5114 Stetson Creek Ct - Applications/Air Conditioner - 08/12/2014FROM :NCR FAX NO. :9702299983 Sep. 25 2014 07:18AM P2i4 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). Air Conditioning ❑ Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Light 0 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). Complete all applicable information on the application. Incomplete applications will not be accepted. Application # OF:> 14-m-t l I �— For office use only Job ` b Site AddreS,S\ ("�IFpUlrgd) /� `-%iI� C1D c�M. 0An.1!_ i Owner Applicant Name Contractor Contractor City of Ft. Collins Sales Tax # Bales tax nuirdw is WiAt d by a# contradom Address Address Address Date � - IZ-,Li Value of Construction (labor, materials, profit) City/State -5'A- Zip Phone City/State Zip Phone City/State f =1 C 111V%Qip Phone CT. b Are you paying taxes here or by report? ere ❑ Report Are you paying with your trust account? Zes ❑ No Is this a residential or commercial project? ZResl ential ❑ commercial If residential, is it: ❑ Single Family Detac ed 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 SO years of age or more? D Yes /" No If yes, you may nechd to contactHistonc Prmwrvahon If this is for a demolition permit, what year was the building constructed? If prior to 1975, you will need an asbestos assessment to submit with thls application. Description of work di *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subeantraetomi Llst the company name or aty 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. �W