HomeMy WebLinkAbout4560 Larkbunting Dr - Applications/Air Conditioner - 08/05/2016City ®f
�®rt 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). Q/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 # YJ t ioo-4 `J-J5
For ofce use only
Date !KL /I �
lob Site Address (required)
Value of Construction (labor, materials, profit) $ 6500
Property Owner Name Address
City/State Zip
Phone
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Applicant Address
City/State Zip
Phone
1Name
Contractor Address
City/State Zip
Phone g170_
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Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? '® Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) t(Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes rw(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 work C" �,, �,,v►14
*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 #
Electrician GPc,-c. Plumber Mechanical Roofer Other
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I hereby acknowledge that I have read this application Viand state that the above information is complete and correct. I agree to
comply with all requirements contained herein and dty;ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: ) = r
Print Name: �V +7� (��L1 �i�.-� Signature Date S
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