HomeMy WebLinkAbout2532 Dallas Creek Ct - Applications/Air Conditioner - 07/19/2016Jul 19 2016 10:19RM PERFECT TEMP
970-282-8699 p.2
For�- t Collins
/ I
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). XAir 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
man ufacturer).
Complete all applicable Information on the application. Incomplete eopllcatlolneiwill not be accepted.
Application #F / to A4 15Date -7- /2 1(::v
For olt9oe vse only
Job site Address (nequlred)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
Cltyistate ZIP
Phone
+E!. C :�c r'
' ate.
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Appllcant dame
Address
City/State ZIP
Phone
Contractor
Address
CIWState Zip
Phone
Contractor City of Ft, Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number /srrqu/re yaj7
"
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it; Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
ElMultifamily (apartment) ❑ Garage
If commercial, is It: 0 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑' Restaurant ❑ Other (explain)
Is this building 5b yedrs of age or more? D Yes 010 if yes, yvu nwyneed to contact H/stlorlcftservatron
If this is for a demolltion permit, what year was the building constructed?
Ifpn'or to 1975, you will need an asbestos assessment to subm/t Wt h this appl/catlon,
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
SubcontrattQrs: List the company name or Ci1'y of Ft CoMns 1/tense 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 e
permit is not valid until It has been paid and Issued.
Applicant;
Print Name; eH/2a Signature
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