HomeMy WebLinkAbout3838 Carrick Rd - Applications/Air Conditioner - 09/06/2017_ r
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coffins
Plannibg, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
�' ,g1JE-COUNTER PERMIT I rConditioning
This arnlication is to be used to apply for the following permits only (checlt all that apply)•
U D .,olition (interior non-structural) ❑ Electrical Alteration (not service change) ❑Gas Lighter ❑Gas Log
fearing Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing [ISewer Line ❑ Photo -voltaic
❑ Ventilation ❑Water Heater ❑Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all aPPlic le information on the application. complete applications will not be accepted.
Application #
For ofTrce use only
3ob — •a Address (ra7ulredl
D,nnarfv Owner Name Address
Applicant Namea __, / S.
�m Van .ac _---
Address
ColtractorA
Coiitractor Cily of Ft. Collins Sales Tax #
soles rda numberrsra9uiredbyall mnbadnrs
Date — -
Value of ConstruobOn bor, materials, profit)
0�
3
city/state
/�q-7A) Phone
l 1� ),I Lf - 7d YS
City/State
C,0
21p
%0%J/
Phone
144911
City/State
Zip
.. .
Phone
Are you paying taxes here or by report? ❑ Here,Report
Are you paying with your trust account? 'yes ❑ No
project? esident a1 ommercial
is this a residential or mmercial roj ❑C
❑Condo/t13 home (single family attached) El Duplex
if residental, Is it-: Single Family Detach .
Multifamily (apartment) ❑ Garage
Ir commercial, is it: ❑ Bank ❑ Bar 0 Chu
❑ other
❑Medical office [I office ❑Retail
❑ Restaurant ou ma need to contad i!%StOrlCPreservatlon
Is this building so years of age or more? 17 Yes` ❑ No Ifyes, y Y
If this is for a demolition perrr►it, what year was the building constructed?
-.. , r o7S you wl/1 need an asbestos assessment to submit with this appl/cordon.
Description of work
�If lawn sprinkler/backflow Preventer, must list It
plumber. If first-time NC, must list licensed electrician.
5ubcontractors:Llstthe mmpanyname orCrh'ofFtCollinslicenseaE Roofer --Other
hlxcriaan__ —
Plumbers--- Mechanical___
!on and to
construction. i know that a
comply u�i have read this
herein and a'ty ordinances es and state laws te that the above nregulating buildingformation Is lete and correct I agree
permit is not valid until it has been paid and issued.
Applicant (�/�/
Print Name.._ Signatures F —