HomeMy WebLinkAbout5400 Jonathan Ct - Applications/Air Conditioner - 05/25/2017Ciof
Fort Collins
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). R 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 applicable information on the application. Incomplete applications will not be accepted
Application # _6176 29 3 Date 5 - - ) 7
For office use only
Job Site Address (required) Value of construction (labor, materials, profit)
Property Owner Name
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Address
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City/State
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Zip
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Phone
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Applicant Name
Address
City/State
Zip
Phone
Contractor Lic # Address City/State Zip Phone
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Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by reportr mere ❑ Report
Sales tax number is required by all contractors '39'3y� Are you paying with your trust account? es R No
Is this a residential or commercial protect? G"Residential ❑ Commercial
If residential, is it- MSingle 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 SO years of age or more? ❑ Yes R-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 AA,P 2 Duc7-)es S p); f S y;g7L,= , t A-) Sy571-1=1215
*If lawn sprinkler/backflow preventer, must list licensed plumber If first-time A/C, must list licensed electrician
Subcontractors: List the company name or Gty of Ft Collins license #
Electrician r %✓l Re e, 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: i / / - S �Z�� 7
Print Maine ems' �r l Signature Date 2