HomeMy WebLinkAbout930 Alexa Way - Applications/Air Conditioner - 12/05/2017-_
79 76 �7
of
Fgrt 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-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ 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 Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on th a application. �Incoomplete applications will not be accepted.
Application # 110V l S Date _ 1,LL-12
ForoAf+c>° usti' only
]ob Site Address (mquired)
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Value of Construction (labor materials, profit)
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Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
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Contractor City of If Collins Sales Tax #
Are you paying taxes here or by report? )8( Here ❑ Report
Safes bxnumberarequlredbyailmnbaclrvs
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Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? O�Residential ❑ Commercial
If residential, is it: � Single Family Detached ❑ Condo/townhorrie (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservabon
If -this is for -a demolition permit, what year was the building constructed? ---• -- ----
Ifpnor to 1975, you hull1 need an asbestos assessment to submit Wb) this applrcabon.
Description of work
*If lawn spnnider/backflow preventer, must list licensed plumber✓If first-time A/C, must list licensed electrician.
Subcontractors: list the company name or OW of Ft Coll/ns ir5cense ,C
Electnaar�"Ch � — Plumbw Mechanical 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 budding construction. I know that a
permit is not valid until it has been paid and Issued.
Applicant:
Print Name: i Signature Date/� JF�