HomeMy WebLinkAbout4518 Vista Ct - Applications/Air Conditioner - 04/18/201504-20-15;08;35AM; ;970-484-4448 # 6/ 12
City of
F„`Ort 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). r Conditioning
Q Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Light r ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement ❑ Roofing 0 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 # bi 5�27 � 1 Date / - Ig-15
For office use only
Sob Site Addres (required) Value of Construction (labor, materials, profit)
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Pro arty Owner ame Address Clty/State Zip Phone
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Applicant Nam;,Address City/state Zip Phone
Shexrl I din la S. 4�tij �,N. re. co y05ay gy0•ggq— ygg1
Contractor Address City/state zip Phone
ors. �iN4 41 F06 6 FO5Ael
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report
Sales tax number IsmquIredbyall conbactom Are you paying with your trust account? `VYes ❑ No
ion1 n
Is this a residential or commercial project? esidential ❑ Commercial
If residential, Is It: l SIngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
4 Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church 0 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contacthllstorlcAtwervc7don
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you will ne an asbestos assessment to submit with this applicadan.
Description of work Q
t
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electriclan.
Subcontractors: Ustthe company name or0yofRColllnsAcenseA'
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: - g 60
Print Name Qf'il 121 reAj Signature l.t.44-4 - ato r/0�/