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HomeMy WebLinkAbout506 Flagler Rd - Applications/Air Conditioner - 06/08/2015?la5ar�t�, Develop-nelr-t L: i pan eaj2 on i:f GE O 281 N. College Ave P.O. Sox 580 lr( co,-Ahns For[ Collins, C0 80524 Phone 970-416-2740 Fax 224 6134 !/ o`t'j Fes" r � ii�? = tf' �hi't: ONLY LY ��ER �� Thls application is to be used to apply for the following permrs on`:y (check ail Lphter❑O it ConditiLogoning ❑ Demolition (interior non-structural) El Electrical Alteration (not service change) Gas 9 ❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing 0 Sewer Line © otD of mlodei and ❑ Ven#ilation ❑ Water Heater ❑ Water Line CI Wood/Pellet Stove (must be EPA certified, provide manufacturer). Complete all applicable i tiorromon Oft ahe appiicat3^n Application # f) I vv `�t for office use onir Sob Site Address (required) Property Owner Name Applicant Name Contractor jz &.1D Address Address Address 4�7" K, Contractor City of FL Collins Sales Tax 9 Sales Y¢x numbs• is required by all con&actors. t.; iiiC6nipiBi? ap7I7_aUons§Ai! ri0'e be acceptsd Date V%agr;e of g'o;isrructaon (labor, materials, r ) C o 8�S :" Sos� f 4 � oC I Gty/state Zip Phone Ir. Co FoSD� oil- 45- C� City,/State Zip Phone CC, CC $oSaS 9-70' Lrs- City/state Zip hhPhone Er.k:a CU. Are you paying taxes here or by report? 0 Here b Report Are you paying with your trust account? Yes ❑ No Is this a residential or commercial project? aResidential El Commercial If residential, is It: IRSingle Family Detached ❑ Condo/townhome (single family attached) El Duplex 0 MuitlFamiiy (apartment) ❑ Garage If commercial, is it. 0 Bank F1 Bar ❑ Church ❑ Hotel/Mctel ❑ Medical of tce El Of,"ce ❑ Retail []Restaurant ❑ Other (explain) �need!oconiactHistoricPreseruaticn -Is this building S® Years of age or more? ❑ Yes �'Mo L-yes, } .ouma} If this is for a demnrtjoii perr:tt, what year was the building constructed? [`prior to 1975, you wflf need an asbestos assesment car submit witfr this apnrca8bn• Description of wori< f � iplac ,�a � *if lawn sprinkler/backi90w preventer, must list wised plumber. If F, st-time A/C, must list licensed electrician. SubcDntractors: List the company name orQt ofF Collins Ilcense Medianical — Roofer Oilier Electrician— Plumber - 1 hereby acknowledge that I Have read this applicator and state that the above information is complete and correct i agree In comply with all requirements contained herein and city ordinances and state laws regulating building constrt!Ctian. i lLno1A' 2s5ai a permit is tact valid until R has been paid and Issued. Applican Print Maine: San"`r'a 05ste 6'd 90b1•-£69-OL6 u11000 V BulleeH ENl-1 03cl