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HomeMy WebLinkAbout3013 Garrett Dr - Applications/Air Conditioner - 05/23/2016�) �'` j Planning, Development & Transportation ®�� o281 N. College Ave P.O. Box 580 'ems®1h Fort Collins, CO 80524 _� n Phone 970-416-2740 Fax 224-6134 \6 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 Lighter ❑ Gas 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, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application # � �Q� o�. 13 Date For oflrce use only J)/ob/� Sii+fte Address (required) Value o Construction (labor, materials, profit) 'I^/) fir/ I 42- ` � ,' f ' �' '.' { .•r � / �,A' �� Property Owner Name Address City/State Zip Phone iA(it-� A NiEE v4- Applicant Name Address City/State Zip Phone DA0�� GSA �- 4 7� 1 €., �a ( '((s _t0 qee I Contractor Address City/State Zip Phone N A(2­0 I A i ( Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report Sales tax number is required by a// contractors Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or c mercial project? Residential ❑ Commercial If residential, is it: Single Family Detach ❑ Condo/townhome (single family attached) ❑ Duplex ` Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank 13 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain ., Is this building 50 years of age or more? ❑ Yes I^ If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? Ifpnor to 1975, you will need an asbestos assessment to submit with this application. Description of work A112 (fey! /i f'P i�e�1l�..� �i 1\nj *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 2 -0 e W '' 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: ���� n ,� Print Name: '/ � `� ' "` signature z ��s ' Date � "