HomeMy WebLinkAbout4632 Brenton Dr - Applications/Air Conditioner - 12/10/2017Planning, Development & Transportation
• 281 N. College Ave P.O. Box 580
Fort Collins, CO 8052-4
Phone 970-416-2740 Fax, 224-6134` ,
()VF,R-THE-001JT PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply).'G7'Ai( ConditonIng
❑ C olition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
i_ ,gating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Venbiabon ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, modal and
manufacturer)
Complete all applicable information on
the application. incomplete apPlIcationDates riill not be accepted
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Application # � l?%1'I�
For office use only
3ob Site Address (I-equired) Value of ConsbracUon (labor, maLenais, profit)
Address City/State r ZIP ^ Phone
Property Owner Namep _ _ ` 1 C t��, f ^ 3Q, p.
i j }�loal k� i Loa, P T `t �O
Applicant Nam@, _, Address J City/State Zip Phone
Contractor
Address City/State Zip Phone
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Conb actor City _f Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here
�at_s cvt numberrsrequnad by all mntracinrsAre you paying with your trust account? ' Yes [I No
11 Is this a residential or commercial project? 0,Residental [I Commercial
If iesidenbai, is it: "0 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) O Garage
if commercial, is d ❑ Banlc ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No Ifyes, you may need to rontadHlstoncPreszra6on
If this is fnr a demolition permit, what year was the building constructed?
Ir,vnor to 1975, you will need an asbestos assessment to submit with this apPACBbon.
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i Description of work
i If lawn spmnkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician
Su bcontra ctors: Ust the MMpeny name Or City of Ft Colbns license a?'
kleai raga--- (lumber.
Mechanical Roofer Other
! 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. .
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Applicant: r ry ]'/n/�- �N - - /j
j Print Name.,l,'4.�n•"'_��`�+ Stgnatvre� l+•_ ��JF_I-7..-