Loading...
HomeMy WebLinkAbout1272 Solstice Ln - Applications/Air Conditioner - 06/26/201506/26/2015 3:52PM FAX 8704044373 IM0001/0002 City of , /11' � Collin Planning, Development & 281 N. College Ave P.O, Bc Fort Collins, CO 80524 Transportation K 580 Phone 970-416-2740 Fax 224.6134 1 OVER-THE-COUNTER PERMITS ONLY This application Is to be used to apply for the following permits only (check all that apply). I:3 Air Conditioning ❑ Demolition (interior non-structural) Q Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log ❑ Heating Unit Cl Lawn Sprinkler C) Mobile Home replacement © Roofing ❑ Sewer Line ❑ Photo -voltaic 0 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 applicatlons will notbe accepted. Application # Date For offl'ce use only — Job Site Address (required) / Value of Construction (la r, materials, profit) S'OI,�' 1Lle, /gL��11` 5�S �a-31.a� la Property Owner Name Address City/State Zip Phone aaaha.tl_.a.s_ �e ne- Appl a t Name y Address City/state Zip D �Phon ^� ,' k4 It 012- � : �,l ` �')�>• gc/.,c/yl/,, r;�,�:{��;T � Le�(y�+'y��a'(b ;''d S-•1',f•�il:n���,3 FsY;Y�.1.:. (Contractor Address City/Statef Zip Phone li; Contractor City of Ft. Collins Sales Tax# Are you paying taxes here or by report? d Here• jitport Sales t.3xnurrnberisrequired byarrcontractors. Are you paying with your trust account?,gJYes o Ne ryyy ,�`J Is this a residential or commercial project? �$esldential ❑ Commercial If residential, Is It: ngle Family Detached 0Condo/townhome (single family attached) ❑ Duplex Multlfamily (apartment) © Garage If commercial; is It: ❑ Bank ❑ Bar L3 Church © Flotei/Motel ❑ Medical office © Office Q Retail ❑ Restaurant ❑ Other (explain) Is this building SO years of age or more? 0 Yes 0 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 w111 need an asbestos assessment to submit with this applicatlon, Description of work e" *If lawn sprinkler/backfiow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician. Subcontractors; Ust the company name or city of Ft Collins license At 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. Appoantl /7o 1 9--L L Sign PrinttName(,,,,, ('0 Data _ fO lot 6