HomeMy WebLinkAbout1846 Indian Hills Cir - Applications/Air Conditioner - 07/13/2016From
07/13/2016 02:51 #259 P.001/001
19� o
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).tAir Conditioning
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O 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 # 911,P0 9470 Date
For oRke use only
]ob Site Address (required)
Value of Construction (labor, materials, profit)
Owner Name Address
City/State Zip
Phone
`Property
Vl
`5.1 L
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? 'VrHere
.Report
Sales tax number is required by all contractors
Are you paying with yourl ust account? K Yes
t1 No
Is this a residential or commercial project? Residential ❑ Commercial
If residential; is it: CPSingle Family Detached ' ❑ Condo/townhome (single family attached) ❑ Duplex
Cl Multifamily (apartment)' 0 Garage
If commercial; is it: ❑ Bank ❑ Bar O Church O Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes O No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you wi/l need an asbestos assessment to submit with this application.
i
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 andicity 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: �\tLp\Q ����. Signature, "AA 34 1�-�Date