HomeMy WebLinkAbout1404 Teakwood Dr - Applications/Air Conditioner - 02/09/2018lPlatinklig, Developinee t & Transportad6n
281 N. College Ave P.O. Box 580
r' Fort Coitus; CO 1 t)524
,..�:..:
., Phone 970-416-2740 Fax 224-6134
....ar. •• is '1
EIRMITS ONLY
This. a Ilcation is to be used to apply for tha foilovylt g per nhi anly,(chec�c ail that apply . Conditioning
❑ ^ :_ )iition (interior non-structural) ❑ Electfical Alteraq.tion (not service change] I] Gas Lighte ❑Gas Log
L� •zting Unit 0 Lawn Spnnider 0 Mobile Home replacement ❑ Roofing ❑Sewer Line Photo -voltaic
❑ Ventilation. ❑ IlUatar Haate"r 17 Watet Line El Wood)Oellet Stove (must be EPA. certified, provide make, model and
manufacturer).
Complete ail applicable informattii-nation
on the application. incomplete application's ill n t be accepted,
Applic�ition # Sw ntr 0/Hate For oh9ca usa only
Sob its Adiir?ss (rrrjuin=d) Value of CoAStruici:ion (labor, materials, profit)OJ
_ leaK ! JcucV;- Co S'65-?-
propz�t. Owpet Name Address City/State Zip
Phone
7� Phone, .
Annlirant Nam ,e,I i - Aaciress � das� f P : ► n..►. iini'v l:sz
AddressCity/State Zip Phon+
Conlraclvr
ConGactoc City of Ft Collins Sales Taz # Are you payfng Wes here or by reporl? ❑ Here
!s' .� iiumbu is ?9ur_ed,byai�cvn�cf;rs Are you paying wlth your trust account? I YPS ❑
Is tlus,a i eslden* T
merciai projectsideht ai ❑ Commergangle Family: Detach df1 CondoJtownhome (single family❑y attached) Duplex
ultifamily (apartmarit) ❑ Garage
It commercial, Is it: ❑Bank ❑Bar ❑ Church ❑ Hotel/Motel El Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building pa years o{,age or morel ❑ Yes II No. IfyPs you may need to conbctHistoricPresenation
If Cliis is. for a"derholataon permit, what year. was the building coristruded?.
Ifi iior tv I975 you r. ,need an asbestos assessment to submit with this application.
Description of work -,,-Y. am .
*if lawn sprinkler/backflow, preventer, must list licensed plumber. If fiir E me AJC, must list licensed elect iclan.
Subcontractors: List tha company name or c/ty of FtWlins license #
Flo��:i�ian_ Plumber.
Mechanlcal Roofer OHier_
f 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 ordinancas and state laves regulating building construction. i lcnoW U3at a
I permit is not valid until it has been paid and issued.
I I
r!O �Ct I
� Pint Name.. 1 � �ar1, Signature-