HomeMy WebLinkAbout2012 Mackenzie Ct - Applications/Air Conditioner - 09/15/2016IT �
iPlannifig, Development a Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
� .7 "l R � 4 T e`er
Ji ic
This application is to be used to apply for the following permits only (check all that apply).�Air Conditioning
Demolition (interior non-structural) ElElectrical Alteration (not service change) ❑ Gas Lighte ❑ Gas Log
1-1eating Unit ❑ Lawn Sprinkler ❑ Mobile Nome replacement- ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
C_I Veniilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model anCl
manufacturer).
Complete all applicable information on tine application. Incomplete applications will not be accepted.
Application #-- SI U0��` �1 Date
For office use only
Sob Site Address (izquiizd) Value of Construction (labor, materials, profit)
Apo, qe_ns;e CL__ � t , 0
m--elOwner Narne Address City/State Zip Phone
Applicant Nam�e^q Address City/State y/State rZip Phone ��p.//,,
Contractor Address City/State Zip Phone
6- 60 1
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Her. ' ,(Repol t
-s _,.. -. ri., 17:unverisf-equi,-edbYaiic017rractors. Are you paying with your trust account? `Yes ❑ No
Is this a residential or commercial project? `.Residential ❑ Commercial
if residential, is it: Single Family Detac ed ❑ Condo/townhome (single family attached) ❑Duplex
1-1 Multifamily (apartment) ❑ Garage
If commercial, ?s it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 0-Office I—' Retail
CI Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑Yes ❑ No If yes, you may need to contact Historic PreseVat%On
If i:his Is for a deiraolition peri-nit, what year was the building constructed?
If cuy ,r to 1975, you r-vlil need an asbestos assessment to submit with this application. —
an
( Description of wor►< rn��P-- ' on — -
�';If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
s ,jbcontreactors: List the company name or City of Ft Collins license ;;
Elcci:rician_
Plumber__ Mechanical Roofer Other
— -
r 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.crly ordinances and state laws regulating building construction. I know that a
hermit is not valid until it has been paid and issued.
A b r
Applicant: • j� i / l0
Print Nam J--k,r— Signature —____--