HomeMy WebLinkAbout1319 Stonehenge Dr - Applications/Air Conditioner - 06/16/2016From:
06/16/2016 07:35 #223 P.002/003
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). [�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 # 9>1 le b 34111S
For office use only
Date k� 1avD
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State . Zip Phone
S
a(- ITZ: s a L- 0
Applicant me' 0 Address
City/State Zip Phone
Contractor Address
City/State Zp Phone
a
Contractor City. of R. Collins Sales Tax #
Are you paying taxes here or by report? WHere *Report
Sales tax number is nequired by all contractors
Are you paying with your trust account? XYes Ci No
Is this a residential or. commercial project? [�Residential ❑ Commercial
If residential; is it: 9Single Family Detached 17 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 pr1or to 1975, you wit/ need an asbestos assessment to submit with this application.
Description of .work _�LA n�,Mt z k-L L
*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.
Applicant: [\ _
Print Name: c��Q _ �'�►\ can. Signature iA��-t • - — Date