HomeMy WebLinkAbout4603 Chokecherry Trl - Applications/Air Conditioner - 03/17/2016From
03/17/2016 04:09 *087 P.001/001
Itt��- Ca'
Fort 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), it Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Gas Log
ideating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement .❑ Hoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water tine ❑ 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.
r
Application # d ivo 1-455 C- �51 (001 sb Date-;zAn\\ u
For office use only .
lob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
t{lQo
City/State Zip Phone
` C�'_
r ` � �l S5 1Zo
Applicant Name
Address
City/State Zip Phone
Contractor
Address
City/State Zip Phone
�
a
Contractor City of Ft. Collins Sales Tax
#
Are you paying taxes here or by report? OHere *Report
Sales tax number & required by all contractors
Are you paying with your trust account? 9 Yes 13 No
Is this a residential or commercial project? irResidential ❑ Commercial
If residential, is it: $3ingle 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 (explain)
Is this building 50 years of age or more? ❑ Yes ❑ 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 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 licersed 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 and issued.
Applicant:
Print Name: ��CID�Q,�yQNT0, Signature . � � •� " - �� Date