HomeMy WebLinkAbout3602 Silvertip Pl - Applications/Air Conditioner - 10/26/201616R552
City of Planning, Development & Transportation
281 N. Cege Ave
FlirtCoR, ins Fort Collins , CO 80524 P.O. Box 580
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). EkAir Conditioning
❑ Demolition (interior non-structural). ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
G 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 #
For o ic40se only
Job Site Address (required)
Value of Construction (labor, materials, profit)
3602 Silvertip PI, Fort Collins 80525
3225.00
Property Owner Name Address
City/State Zip
Phone
Ralph Smith 3602 Silvertip PI Fort Collins, CO 80525
512-924-4522
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
IMS Heating and Air 5213 Longs Peak Rd, Unit A Berthoud, CO 80513
970-532-0123
Contractor City of Ft. 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? q Residential ❑ Commercial
If residential, is it: IN Single Family Detached ❑ Condo/townhome (single family attached) ❑ 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 .❑ 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 Rerzce with a Carrier 2 ton 13 seer AC
*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 #
ElectricianEggerS 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 a
permit is not valid until it has been paid and issued.
Applicant: -
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