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HomeMy WebLinkAbout809 Langdale Dr - Applications/Air Conditioner - 10/04/201610/04/2016 12:58PM FAX 8704844373 fgi0001/0001 City of F6r t Collins (Planning, Development & Transportation 281 N. College Ave P.O, Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6,134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following. permits only (check all that apply -conditioning 0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Q Gas Log ❑ Heating Unit ❑ Lawn Sprinkler M Mobile Home replacement 0 Roofing ❑ Sewer Line © Rhoto-voltaic 0 Ventilation 0 Water Heater ❑ Water Line 0 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 # U Data �016 For office use only Job site A dress (re ufre 1 Value of Constructi n (labor, m terials, pra it) bra' �e Co I Gu -0--. P{rroperty Owne/� ame Address Cityy/$'tate Zip Phone Applicant Name Address City/State Zip i Phon Contractor Address City/State Zip i Phone 1 t:) 'e.r t'�. , r •, �. / li lO Co r i�n'i5 i-, dC-. i 'h'i t,t (:''L1�:' :1 t'l'7Fr:at.�.9 Contractor City of Ft, Collins Sales 7'a # Are you paying taxes here or by report? 4 Here ,,)report Sales tax number Is required by all contractors Are you paying with your trust account? /1Yes © No _�' -.�� 6 Is this a residential or commercial project? esl entlal ❑ Commercial If residential, is it; ❑ Single Family Detached © Condo/townhome (single family attached) ❑ Duplex Q Multifamily (apartment) 17 Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 0 Medical office ❑ Office 0 Retall ❑ Restaurant ❑ Other (explain Is this building 50 years of age or more? 0 Yes fyes, you may need to contact H/stor/c p��serva� If this Is for a demolition permit, what year was t bullding constructed? If prior to 1975, you will need an asbestos assessment to subnllt with this application. " Description of work *If lawn sprinkler/backflow preventer, Must list licensed plumber. If first -time -A/C, must list licensed electrician, Subcontractors: t/st the company name or City of Ft Collins license # Electrician Plumber_ Mechanical Roofer Other-. 1 hereby acknowledge that I have read this application and state that the above information is complete and c�rrect. I agree to comply with all requirements contained herein and city ordinances and state laws regulating building constructlton. K know that a Permit is not valid until It has been paid and Issued. Applicant: Print Name: o-, si.natu Data