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Home My WebLink About3914 Galileo Dr - Applications/Air Conditioner - 06/27/2016From 06/23/2016 08:45 #236 0.001/001 1gcRS9 City ©f Flirt CoLle s Planning, Development ik Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 This, application is to be used to apply for the following permits only (check all that apply). E;Mr 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. �'vt� Ce)pD "� 7 Application # 2AADS- *3 Date l �� For ofce use only Sob Site Address (required) Value of Construction n (labor, materials, profit) 1; O-c --�c ae2 -- Property Owner Name Address City/State Zip Phone + 3 --- Applicant Name Address City/State Zip Phone Contractor Address City/State Zip Phone a Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ItHere .Report Sales tax number is required by all contractors: Are you paying with yourtrust account? X Yes 13 No Is this a residential or commercial project? \93-kesidential ❑ Commercial If residential; is it: gle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Aultifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 58 years of -age or more? ❑ Yes ❑ No If yes, you may need to contactHistoric 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 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 0 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: y` Print Name: NLC Signature.