HomeMy WebLinkAbout7009 Sedgwick Dr - Applications/Air Conditioner - 07/01/2015From:
07/01/2015 04:15 #727 P.001/001
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). gAir 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 # g 15050 34 Date
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
aI
o
Property Owner Name Address
City/State Zip
Phone
S
s- q q_-Dr 171
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? WHere
*Report
Sales tax number isMuiredbyall contractors
Are you paying with your trust account? XYes
El No
Is this a residential or commercial project? 4PResidential ❑ Commercial
If residential, is It: t?Zingle 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? ❑ 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 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 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: (� /1 ,
Print Name: ` ` LC M Signature0. Date S
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