HomeMy WebLinkAbout5937 Greenridge Cir - Applications/Air Conditioner - 04/14/2017Ciof
,�'Ort collbs
PlannIA9, Development & Transportation
281 N . OpIlege Ave • ; P.O. Box 500
Folt C0111ns, Co 80524
Phone 00-416-2740 Fax 22+6134
OVER-T � OQNT R: PERIT ONLY
This application is to 6.e used_ to apply for irhe foilorvlpg;perr only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) 0 Electrical Alteration (not serv1661:1. change) ❑ Gas Lighter ❑ Gas Log
B ahng Unit ❑ Lawn Sprinkler ❑Mobile home replacement l7 Rodting `O Sewer IJne 0 Photo -voltaic
❑ Ventilation ElWater Heater ❑ Water Line 0 Wood/Peilet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application: Incomplete applications will not be accepted.
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Application # 1/ I I I Date 'i - y
For oRice use only
lob Site Address ilrequ/red).
Value of Construction (labor, ma erlals, profit)
o0
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Cr$0
5,2V
etty owner Name
Qdress
❑ty/State Zip
hone
5
AuolTlcanE Nam
Address
d state Ap
Phone
Ilia b
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Contractor
•
Address
,
city/state Zip
cfoal/
Phone.
dgiiti cbor Clty of FL Cplilns Sales Tex #
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Are y0L. paying ta?ci s here or by report? ❑.Here
Are you paying with your trust arcount'i 4fj'es
`Report
❑ No
s „c,,,} ,ayy�d/,yaua
Ls this a residential or oomm ai project? E Residential 4 (Pommerdal
If resitlentlal, Is It ngie Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (aparlinent) L Ga►age
If commercial, Is it: ❑ Bank ❑ Par ❑ Church O, FloteljMotel ❑Medical office ❑Office ❑Refill
0 Restauran't ❑ Other Cexplaln)
Is this building so years. of age.or more? 0 Yes 0 No Ifyes� ydri rirayneed m contact HlstorfcPrrsWIatlon
If this Is for 'dermolldon permit, what year was the building egristructed?
Ifprior to 1975, you w1/% need an asbes6�s aisess-m6fit to submit i069 ib /& app/kadon.
Description of work,-Y►�a�k rs _ I. �e—
*if lawn sprinkler/baddiow pn venter, must list /loaned plumber. If first-eme Ajc, must list licensed electrician.
Subcontractors: List Me cvmpanyname orQtyofFt cblllns//a� Ar
Eectidan 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 hereln and dry ordinances and state laws regulating building construction. I know that a
permit Is not valid until/It hasbeenpaid and Issued. /!
Applicant Tim,
Y / TO 1 Y
Print Name 4 rx. ^Ignature. N 4"