HomeMy WebLinkAbout209 Princeton Rd - Applications/Air Conditioner - 06/24/2016� {< •.d Y �,•.y .PZyl::r.:9 'a� :�{ �i :S :� Y;f r,,,yd/
Planning, Development a Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-613A1
pan �`� �U iN TLY
.
This application is to be used to apply forthe following permits only (check all that apply). Air Conditioning
❑ Daii-ioiition (interior non-structural) ❑ Electrical Alteration (not service change) El Gas Lighte Gas Log
❑ I-Ia<ting Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sevver Line ❑ Photo -voltaic
Cl ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Comp'lote all applicable information on the application. Incomplete applications will not be accepted.
I
Application t U� 10D Date �'ay & ---- For office use only
+o_b 5're
AdHrass (AE17uire) Value of Construction (labor, materials,, profit) 00
4( —
3
10-
o —eo 80m -1-1ln
--—
fPei Ownel• Name Address City/State Zip
Phone
X � 5kAU J W, a70-
.
Agpplic . t Name- Address City/State Zip
Phone
l� Ll�li*t.l�. I O5ILJ
�'1®'gI
ContraLtor._ Address City/State Zip
Phone
t ' 1/!Vr_ 4//
Contra, for City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
❑ Here�Repol t
U.r lIL1177ber k; required by all contractors Are you paying with your trust account? ' Yes ❑ No
Is this residential or c mmercial project? Residential ❑ Commercial
[f residential, is it: Single Family Detached . ❑ Condo/townhome (single family attachecl)
ElDuple;<
Multifarnily (apartment) ❑ Garage
If comliiercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
[s this building So years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact Historic Preservation
If this is for a denaoiirio.a permit, what year was the building constructed?
Ir;.cvjorl to 1975, you aviil eel an asbestos assessment to submit with this application.
DescriPi tion-of work � v
r
---
-
r if la id 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 ;f
I:10cC1.1c;iai7_ _ Plumber _ Mechanical _ RooFer — Other
[ hereb)i acl<novvledge that I have react this application and state that the above information is complete and col rect. I agree to
comply I11th all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit Iis not valid uniil it has been paid and issued. ggrr
App;icalrt. r ,
.Print NUlna`
Signature