HomeMy WebLinkAbout3460 Laredo Ln - Applications/Air Conditioner - 09/26/2018v Planning, Development, & Transportation Services
.fort Collins Community Development & Neighborhood Services
bps - 281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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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 Beater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # V01060166LA Date
For office use only
Job Site Address (required) Value of Construction (labor, m terials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address Cit /State Zip Phone
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Contractor Address City State Zip Phone
t C6 ° Z 7702/9-7 '
Gontrac r City of F Collins Sales T x # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales lax number/srequired by al/contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, Is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar Q Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑. Other (explain)
Is this building 60.years of age or more? ❑ YesXNo /fyes, you may need to contact Historic Preservatlon
If this is for a demolition permit, what year was th building constructed?
Description of work il6z a '
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license ;0
Electrician Plumber Mechanical Rooter Other
1 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.
Applicant: ` 1 W /
Print Name. Signature U Date
Revision date 21612e17
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