HomeMy WebLinkAbout2713 Silver Creek Dr - Applications/Air Conditioner - 08/15/2017Fort 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-COUNTERPERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply).kAir 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 #]�:)no4toyj
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lob Site Address (required) T--V Co tt kM' Ca Value of C (labor, materials prodo
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Property Owner Name Address
City/State ti(� �� Zip
Whom..l�D?aJ
ffApp'rint Name Address
City/State , Zip
Phone
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Contractor Xv-Address
City/State Zip
Phone
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a-!Q)
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
(Here ❑ Report
Sales tax number & required by3Ywatractars
Are you paying with your trust account?
❑ Yes )No
Is this a residential oElultifamily
mercial project?
If residential, is it:ngle Family Detached
(apartment)
sidential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel Madical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need c actHis[nricPleservatlon
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.
Of
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List fire company name or City of Ft Collins license,{#
Decindan lea '�p Plumber Mechanical ! ,I W� 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: (�C l ,kt \Y Print Name:
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