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HomeMy WebLinkAbout3212 Grovewood Dr - Applications/Air Conditioner - 07/11/201707/11/2017 2:57PM FAX 9704844373 16000110001 City of Planning, Development &Transportation 2-81 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER-THE-CCLIINTER PERMITS ONLY This application Is to be used to apply for the following permits only (check all that apply), 0Air Conditioning ❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) 13 Gas Lighter © Gas Log ❑ Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic CI Ventilation 0 Water Heater O Water Line M Wood/Pellet Stove (must be EPA certified, provide make, moeel and manufacturer). Complete all applicable Information on the application. Incomplete applications will not be accepted. Application #_ 01p Date for office use only - Job Site Address (required) Value of Construction (la3or, materials, profit)r� Property Owner Name Address City/state Zip Phone Applicant N me Pp - T Address City/State Zip Phone • r/ tr.�.. •r...-�✓,�,\r. .;.��•.�'. .. (`, 1Ci'7,:r •�C, \�lw C'rYl(Y1CN C4 '� !., f Contractor Address Clty/SL'ate Zip Phone )_ (rlCO �� ,;•n .Lr_1 (�' 7 rr._� _Gu_ 1 I) +, C� %/) 'v(�, , Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ,Aa�report .satestax number fsrequtrCdbya//contractors. Are you paying with your trust account?yByYes ❑ No'vc:, Is this a residential or commercial project? 1pbReSldential ❑ Commercial If residential, Is it: Vf Single Family Detach d C1 Condo/townhome (single family attached) ❑ Duplex '1 Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel Cl Medical office ❑ Office ❑ Retail ❑ Restaurant 0 other (explain) Is this building 50 years of age or more? ❑ Yes Q No If yes, you may need to contact Hrstoric preserv,�tion If this is for a demolition permit, what year was the building constructed? „___ _ __ _ If prlor to 1975, you w/ll need an asbe5tiOS assessment to submit with this ijpplicatlon,� *If lawn sprinkler/backnow preventer, must list licensed plumber, If first-time A/C, must list licensed Fhlrtririan Subcontractors: UstthecompanynAmeorCity OfF!'Coll/ns•license/f Electrician Mechanical_,_ ,_ Roofer 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. % know that a j permit is not valid until it has been paid and Issued, Applicant: Print Name:, Signature/ Date