HomeMy WebLinkAbout4407 Goshawk Dr - Applications/Air Conditioner - 04/25/2017PlannInM Devebpment Ilk Tiranspartatlon
281 N. College Ave P.O. Box 580
Fort Collins, 00 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following penmtls only (check all that apply). 0 air Conditioning
O Demolition (interior non4tructural) O Electrical Alteration (not service charge) 0 Gas Lighter 0 Gas Log
O Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement D Roofing 0 Sewer Line 0 Photo -voltaic
0 Ventilation 0 Water Heater 0 Water Line 0 Woodiftlet Stowe (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable informa"— — tho application. Incomplete applications will not be accepted.
Application # I J Date 17-1 -,?S / r%
For olf m asre on#,
Sob She Address (wukd)
- - Vahre of O mAnKtIon (labor, materials, profit)
Property Owner Name Address
City/state Zip Phone
P 3
1 aka 7 _dJ4_ �7od
Apoicant Name Address
City/state Zip Phone
Contractor Address
aty/State ZIP Phone
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S -1=-
Contractor City of f1f Collins Sales Tax t
Are you paying taxes here or by report? $ Here 0 Report
sales�t�r?M'716 rEsn�iedbyaraurbanors
Sye?�S-�
Are you paying with your trust account? O Yes 0 No
Is this a residential or project? Residential O Commercial
If residential, is it: Single Family Detached 0 Condo/townhome (single family attached) O Duplex
Multifamily (apartment) 13 Garage
If commercial, is it: 0 Bank 0 Bar 0 Church O Hoted/Motel 13 Medical office O Office O Retail
0 Restaurant D Other (explain) s
Is this building 50 years of age or more? O Yes O No IfM you may need to contact HNork Phew vabon
If this is for a demolition peradt, what year was the bcdkdirg constructed?
I rfp j r`to 1975, you w//l need an asbestas assem7mt fo svbn*Wth Mis aAWAw & ---
Description of work
*If lawn sprinkler/baddlow preventer, must list ficerrsed plumber. If first-time A/C, must Ilst licensed electrician.
Subcontractors: fist Me company name or Cry of R Cafts Ncros? 0
Ele�ida� Plumber Medrerd®I Roofer DOW
I hereby admowiedge 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: ✓�' Signature Dale Y"aS 'l%
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