HomeMy WebLinkAbout1301 Ticonderoga Dr - Applications/Air Conditioner - 07/17/2017Planning, Development & Transportation
281 N. College Ave P.0 Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224.6134
OVER-THE-COUNTER PERM145 OVA /Ir Conditioning
This anpiication is to be used to apply for the following permits only (check all that apply). t�C6
Lj r -. alition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
C 1-iaaung unit ❑ Lawn Sprinkler El Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
J Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model anti
manufacturer)
Complete all applicable information on the application. incomplete applications will not be accepted.
Application _ ?J �I O 45 �
For offrca use Only
Job SitesAddress (required), ..
�S
v Owner Name
Date --
Value of :Construction (labor, materials, profit) i
�
City/State Zip Phone
- I -
City/State 7rp Phone ^
Pry. l - - Phone
Contactor
Address Clty/State zip
of Ft. Collins Sales Tax # Are you paying taxes here or by report. ❑ Here
Report I
Contactor Gty Are you paying with your must account? ' 'Yes ❑ No
&I,nunrber�bYal/omn(rads or
/A[f
-----" esidential ❑ Commercial
is this a residential or co ercial project? family ) ❑ Duplex
Tf residential, is it' Ingle Family Detached 0 Condo/townhome (single attached p
❑ Multifamily (apartment) ❑ Garage
it commercial, is it. [I Bank ❑ Bar ❑ Church ElHotel/Motel ❑Medical office ❑Office d Retail
❑ Restaurant ❑ other (explain) u may need to ron[adHistor/cPreservation
is this building So years of age or morel ❑Yes ❑ No Ifye;. ya
If this is for a demolition permit, what year was the building constructed?
I eed an asbestos assessment to submit with this Opp/leaban
lr,Oii,)r to 1975, you will n.
Description of work _ je Dv1d— ---• —
-IF lawn sprinkler/backHow preventer, must list licensed plumber. IF first time A/C, must list licensed electrician
'
( subcontractors:unf�emmpanyname orc7ty GbUIns/icense� RaoFer_ Other —
Ekc-tnciau— - ---
Piurrber�— mechanical -
I hereby acknowledge that I have read this applimtion and state that the above information is complete and cormcL I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. i know that a
I permit is not valid until it has been paid and issued.
I Applicant: !� �n .&URIV !Signature
Ls , 'Z1[
1 Print Name,---r