HomeMy WebLinkAbout4543 Seaboard Ln - Applications/Air Conditioner - 06/16/2016From 9702299983 1.970.229.9983 Thu Jun 16 09:19:19 2016 MDT Page 8 of 8
FROM FAX NO. Jun. 16 2015 03:16PM P8i8
City Of planning, Development&Transportation
Q�Y,� �C���lCl� 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). Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Light ❑ Gas Log
❑ Pleating 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 # d? ] Spit_ 3�0 9 Date
For ofce use only
Sob Site Address (raqulred)
Value of Construction (labor, materials, profit)
4543 SEABOARD i,N
3 295,00
-
Property Owner Name Address
City/State ZIP Phone
BRIDGE T COCHRAN 4543 SEABOARD LN, FTC CO 80,5 5_
Applicant Name Address
City/State ZIP Phone
Contractor Address
City/State ZIP Phone
NORTHERN COLORADO AIR, INC. 812 STOCKTON AVE FT COLLINS CO 80524 970-223-8373
Contractor Oty of R. Collins Sales Tax #
Are you paying taxes here or by report:? J!f Here ❑ Report
5alestax number isrequired bya//contractors.
Are you paying with your trust account? JKYes ❑ No
26862
Is this a residential or commercial project? EfResidential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
9 Multifamily (apartment) ❑ Garage
If commercial, is it: O Bank 17 Bar ❑ Church 17 Hotel/Motel ❑ Medical office ❑ Office 13 Retail
❑ Restaurant ❑ Other (explain) ._.,...... _......
Is this building 50 years of age or more? ❑ Yesg No If yes, you maynced to contact Historic Preservation
If this is for a demolition permit, what year was a building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this applira6on.
Description of work
*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 and Issued.
a
Print Name: I' �_ J I L Signature _�v .Date V•. -f � `'