HomeMy WebLinkAbout4148 Sumter Sq - Applications/Air Conditioner - 10/14/2015From 9702299983 1.970.229.9983 Wed Oct 14 16:11:17 2015 MDT Page 1 of 1
Planning, Development & Transportation
City of 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 Lights :1 Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line El 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 #, 11 ISO 7 K H Z Date ��-
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
LA- '� LR
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Property Owner Name Address City/State Zip
Phone
Applicant Name Address City/to Zip
Phone
Contractor Address City/state F-CpIkl1 cZlp
Phone'"Y7TO
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here
El Report
5a/estax number isrequired byall contractors Are you paying with your trust account?
❑ No
Is this a residential
If residential, Is It:
If commercial, Is It:
or commercial project? 7 Residential ❑ Commercial
Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explai )
Is this building 50 years of age or more? ❑ Yes (explain)
If yes, you mayneed to contact HrstoricPreservation
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 applicafion.
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 Colons license #
Electrlclan 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. if
Date %Ow C