HomeMy WebLinkAbout2217 Loyola Ave - Applications/Air Conditioner - 07/07/2016From
07/07/2016 04:01 #253 P_001/002
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FCilirt Collins
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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). 45: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 # $I1P0 3 q 01p Date
For office use only
lob Site Address (required) Value of Construction (labor, materials, profit)
Aa )-, L i. cAa ice. LI5-191y
Property Owner blame Address City/State Zip - Phone
Applicant Name " Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? WHere .Report
sa/es tax numbers required by all wn&actors Are you paying with your�trust account? A Yes 13 No.
is:
.this residential or commercial project? Residential ❑ Commercial
If residential, is it: 1pingle Family Detached ❑ Condo/townhome (single family attached) - ❑ Duplex
❑ Multifamily (aparUmnt) ❑ Garage
If commercial, is it: ❑ Bank 17 Bar ❑ Church ❑ Hotel/Motel Cl Medical office O Office ❑ Retail
i . ❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 0 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 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: h • %f
Print Name: ` `�C�` �►� �� Signature . - k &'�L a- ` - ��-- Date —1