HomeMy WebLinkAbout307 Skysail Ln - Applications/Air Conditioner - 06/05/2015From:
06/05/2015 09:24 #690 P.001/009
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City Of planning, Development & Transportation
281 N. College'Ave P.O. Box 580
.Fort 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). Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ 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.
Application # 5 15o /vl -�T-1 Date _ (P
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
,� 1 5
Property Owner Name Address
J
City/State Zip
Phone
nk
f C D alo
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Applicant Name Address
City/State Zip
Phone
a 3Ut.
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-b-783
Contractor Address
City/State Zip
Phone
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? II (Here
*Report
Sales tax number&& quired by all contractors
Are you paying with your trust account? KYes
a No
Is this a residential o ommercial project? q( Residential ❑ Commercial
If residential, Is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar O Church O Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
0 Restaurant ❑ Other (explain)
Is this building SO years of age or more? O Yes ❑ No If yes, you may need to contact Historic Preservation
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 appllcadon.
Description of work
*If lawn sprinkler/backfiow 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 #
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:
Print Name:��CD�Q_ L7i� Xrm Signature,