HomeMy WebLinkAbout814 Arbor Ave - Applications/Air Conditioner - 09/07/2017planning, O.eveloprnent & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-5134
0 F _-Tm 017 TER PERMITS ONC irConditionin
This application is to be used to apply for the following permits only (check all that apply). g
ij •:,li6on (interior non-structural) ❑ Electrical Alteration (not service change) 17 Gas Ulghtef ❑ Gas Log
eating Unit ❑Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
ter ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
❑ Ventilation ❑ Water
manufacturer).
s application. Incomplete applications will not be accepted.
complete all applicable information on tit
r 11 � -
Date Application # 10
A7r office use only
Sob Site Address (required)
I� Arb0_r
Pro elty Owner Name
A /!)p^licanl� amen m I/anik4_ n__._.._—
Address
_ ri
Address
/ L
Address
Contractor City of Ft. Collins Sales Tax #
_ os taa number^ 9uA by all ron-acdrs•
Value of construicaon tlao r, urar.arn , ,�
-, / 20 -�
Phone
City/State Zip
2s
City/State ZIP
City/State Zip
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Phone
Phone
Are you paying taxes here or by report? ❑ Here
Are you paying with your trust account? 'Yes ❑ No
is this a residential or connmerdal project? Jgl�,Resi ential ❑ Commercial Duplex
If residenti5l, is It: C *Single Family Detached ondo/townhome (single family attached) ❑
Multifamily (apartment) ❑ Garade
Ir commerdai, is it: ❑ Bank ❑ Bar ❑ Church 0 Hotel/Mote! ❑Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain) ou maY need to contact Historic Preservation
Is this building sa years of age,or more? ❑ Yes' ❑ No ling Ifyes, y
If this is for a demolition W/�i n permit, eed an asbestos assess e t to ear was the subm ry M this application.
rf F�iior to 1975, Y
Description of work
*if Lawn sprinlder/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: List the company name orCYyofFtCollins license 0 Roofer`._--- Other
Plumbcr� Mechsnlcal�
f hereby acluiorovled9e that I have read this appli�tion and slate that theabove information is complete and correct. I agree to
comply wiui all requirements contained herein and city ordinances and state laws regulating building construction. i know that a
permit is not valid until
'ithas been paid and -issued.
app;icant: ' / %� 1 �n r 1 � L/� . signature
Print Name_,. ar