HomeMy WebLinkAbout1615 Fantail Ct - Applications/Air Conditioner - 04/24/2015From:
04/24/2015 08:11 #635 P.002/004
City of Planning, Development & Transportation
f 281 N. College Ave P.O. Box 580
/ Forlt Collins`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). EI Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) Q 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).
Complete all applicable information on the
application. Incomplete: applications will not be accepted.
' nApplication# 1 rd Il 4( Date
lob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
5
-1
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
a
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report? ItHere
*Report
Sales tax number & required byall contractors
Are you paying with your trust account? XYes
C3 No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: 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? 0 Yes ❑ No If yes, you may need to contact Historic Preseryation
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 this application.
Description of work
*If lawn sprinkler/backflow 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
Electric1anYX1L-eM 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: ^' /1 1, 1 C
Print Name: ` ` LLQXe _ lT\ Q_� )) Signature. + � � Q .. Ib Date _6 1J _