HomeMy WebLinkAbout1824 Overlook Dr - Applications/Air Conditioner - 04/25/2016Planning, ;D•e-Veloprnent & Transportation
281 N. College Ave P.O. Sox 580
I I � Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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) El Gas LighteGas 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, modal and
Manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
;-Application # —6 IQ 0_2 160 Date �� ��5• �e� -
For officO use only
lab Site r;cicir.=ss (raquii2d)
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Value of Construction (labor, materials, profit)
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r p-rty OwnerNan e Address/� City/State Zip
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Applicant Name Address
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City/State Zip
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Phone
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ConLraCtor^ Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here .Report
ScL- ti.\ Inunberisrequiredbyall c tractors.
Are you paying with your trust account?
V_Yes Cl No
Is this a residential or commercial project? esidential ❑ Commercial
If residential, is it: ingle Family Detached 0 Condo/townhome (single family attached) El Duplex
'❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
is this building So yeaa-s of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contact Historic Preservation
If this is for a demoiitioi3 perritt, what year was the building constructed?
ifplior to 1975, you wiil need an asbestos assessment to submit with this application.
Description of work D U2 P�LI
;r [f 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
L"I�clrician__ Plumber- Mechanical Roofer — Other
r I,erol,y 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.
Print NameSignaltureA mar ate—--_--_--