HomeMy WebLinkAbout3004 Parkview Ct - Applications/Air Conditioner - 09/02/2015f=ro m:
09/02/2015 06:46 #all P.001/001
of
��®rt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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). tAir 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 # 13150`S54 Date
For office use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
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3 �3
Property Owner Name Address
City/State Zip
Phone
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-
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
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8
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? It (Here
.Report
sales tax number is required by all contractors.
Are you paying with your trust account? 9Yes
[y No
Is this a residential or commercial project? 'Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
El 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 Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprlor 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 9
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:` \l GMe_\XM Signature, • o Date