HomeMy WebLinkAbout2619 Platte Pl - Applications/Air Conditioner - 06/17/2016From
06/17/2016 05*24 0225 P.002/002
19
FCiof
ort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER -TIDE -COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply).�Oir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
tir_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 #_ �%� U%'`/� Date mot 1�,11p
For ofte use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
3r-c-.\k..
City/State Zip Phone
1
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
a
Contractor City of Ft. Collins Sales Tax #
Sales tax number iswuiredbyall eondactors
Are you paying taxes here or by report? OpHere .Report
Are you paying with your -trust account? 9Yes 13 No
Is this a residential or commercial project? residential ❑ Commercial
If residential; is it: ingle Family Detached ❑ Condo/townhome (single family attached) - ❑ Duplex
El Multifamily (apartment) 0 Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of; age or more? ❑ Yes ❑ No If yes, you may need to contact Hlstorrc 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
*If lawn sprinider/bacidbw 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 Mechardcal 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:_NL�Q Q, y"ey'r..' Signature x�e . a - • ��— Date