HomeMy WebLinkAbout1213 Cliffrose Ct - Applications/Air Conditioner - 09/23/2016SEP-14-2016 10:07AM FROM -
9704848354 T-197 P.009/010 F-087
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). ❑ 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 applicableinformationon the application. Incomplete applications will not be accepted.
Application # 1 �Date SEP 2 3 2016
For offilce use only
Job Site d (mvwred)
0' 1 .12
� rosC, C •
Value of Construction (labor, materials, profit)
461zm
Property ner Name IfJT�rOM
Sri Z
City/S t Zip
) ' s afz5
Phone
215-0
Applicant Name Address
City/State Zip
Phone
Fort Collins Heating and Air 208 Commerce
Dr. #4 Fort Col I his, Co 80574
(970) 305-3478
Contractor Address
City/State . Zip
Phone
Fart Collins Htat
iing and Air 208 Commerce Dr. #4 Fort Collins, CO 80524
970 484-4552
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number Is►equlmdbyall mntroctors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? O Residential ❑ Commercial
If residential, is it: 40 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: Q Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpn'or to .1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subeontracbors: List the company name or City of Ft Collins licensee #
Electrician Plumber Mechanical H1309 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:
Print Name: Angela Morrow Signature
Date �IZ116