HomeMy WebLinkAbout2606 Shadow Mountain Dr - Applications/Air Conditioner - 05/06/2015May 06 2015 8:03RM PERFECT TEMP 870-282-8698 P.1
Planning, Development & Tram sportatlon
�.0ty Q � tins For 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).r�Alr Conditioning
El Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 13 Moblle 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.
Appllcation # t:)� Date
For alflee use only
K'. 49. /6'
Job Site Address (n quuedj
Value of Construction (labor, materials, profit)
3 15 A-5. CO
Property Owner Name Address
Clty/State Zip Phone
C Sex, 66.5,4,& u).
d7W. U,44.6 ��a�►-'� �'a%G' 4 --) 62
Applicant Name Address
City/state ZIP Phone
t ITS ' -3o' .,,917n `.7I"
Contractor Addd/1ress
City/state Zip Phone
+f�'�'�
.1/r/
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
5ekstaxnum6er�rrbqulix+dbyaNenrtr�einr8�//
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ,q Residential ❑ Commercial
If residential, Is It: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
gMultlfamlly (apartment) 17 Garage
If commercial, Is It: 13 6ank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Offlce ❑ Retail,
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? o Yea A No 0 ws, you may need to contactH/stvNc Prrservaifbn
If this Is for a demolltIon'permlt, what year was the building constructed? .
Af pr/or to 1975, you will need an asbastew asswment to submit W0 this appl/catfon.
Descrlptlon of work A <� /5%L�&7'I
*If lawn sprinklertbaddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.'
Subcontractors: List the company nar»e or CRY of coll/ns fkafim 0
Electiician ' !-; '5A1 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 to not valid until It has bean paid and Issued.
,applicant:! Ui. /7-J
Print Name; Signature
onto e "e_'.' 16