HomeMy WebLinkAbout7112 Silver Moon Ln - Applications/Air Conditioner - 08/19/2019Planning, Development & Transportation
CCity Of 281 N. College Ave P.O. Box 580
_! Ort 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).
-,�ir Conditioning ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ 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 # JNg6�R,4 Date
For office use only
Job Si Addrfss (required)
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Value of Construction (labor, atenals, profit)
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Property, Name
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Address CCity/State Zip Phonnee,,
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Address e-,O� City/State Zip
Phone
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Addr ss City/S to 1,0146 Zip
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Phone
Co tractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? mere ❑ Report
Sales tax number isr uiredbyall contractors Are you paying with your trust account? ❑ Yes
><,No
Is this a residential o commercial project? Residential ❑ Commercial
If residential, is it: Single 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 (ex lain)
Is this building 50 years of age or more? ❑ Yes o Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
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*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 Ft 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 d issued.
Applicant:
Print Name: Signature Date
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