HomeMy WebLinkAbout1080 E Elizabeth St - Applications/Air Conditioner - 08/15/2017Pale, 1°b z
City of Planning, Development & Transbbortation
281 N. College Ave P.O. Box 580
Ort C011ins Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). D 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 Healer ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
f
anu a mcturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # e i-10 41 re
-
For ofte use only
Date 08/15/2017
Job Site Address (required)
Value of Construction (labor, materials, profit)
1080 E ELZABETH ST
$3,380.00
Property Owner Name
Address City/State Zip
Phone
DR NELSON BACHUS
1080 E ELIZABETH ST, FTC CO 80524
970-484-3323
Applicant Name
Address City/state Zip
Phone
Contractor
Address City/State Zip
Phone
NORTHERN COLORADO AIR INC.
812 STOCKTON AVE, FT COLLINS CO 80524
970-223-8873
Contractor City of Ft. Collins Sales Tax
# Are you paying taxes here or by report?
O Here ❑ Report
Sales tax number isrMuvedby0contractom
26862
Are you paying with your trust account?
N Yes ❑ No
Is this a residential or commercial project? El Residential ❑ Commercial
If residential, is it: O 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 D Other (explain)
Is this building 50 years of age or more? ❑ Yes ONO If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work REPLACE AC
rr wwn spnnKler/oacknow 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 Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. 1 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: KARENA-
Print Name: KARENA HUNTWORK Signature HUNTWORK ----
b. A�, 1�M utl,l OV
Date 08/15/2017