HomeMy WebLinkAbout1316 S Lemay Ave - Applications/Air Conditioner - 09/20/2018Cityof Planning, Development, & Transportation Services
_Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, Co 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply).-ZAkr 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 the application. incomplete applications will not be accepted.
Application # e) Date Septiemtw-r 20, 2018
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
1316 S Lernay, FortColl,Lnw, CO 80524 $4173.00
Property Owner Name Address City/State Zip Phone
severty'eeck. 1316 S Lentay FortCoul4w,, CO 80524 970-379-0052
Applicant Name Address City/State ZIpp Phone
CPwtstfauvEvavw 101 S LLnk Lane Ft Co, CO 805Z4 494.7632
Contractor Address City/State Zipp Phone
AUevvServ(.ce� 101 S Ltnk•Lai& Ft Co-, CO 80524 484-4841
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ J.iere ❑ Report
Sales tax number is requiredbyall contractors. Are you paying with your trust account? VYes ❑ No
10010
Is this a residential orymmercial project? Residential ❑ Commercial
If residential, is it: `M Single Family Detached ❑ Condo/townhome (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 HistorlcPresenotion
If this is for a demolition permit, what year was the building constructed?
Description of work Renoy&ex Wo%q,AC aluLreplace wU-;vUkerrtiew AC
*If lawn sprinkler/badrflow preventer, must list licensed plumber. If first-time AJC, must list licensed electrician.
Subcontractors: List the companyname or City oFa Collins license #
Electridan Plumber. 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 building construction. I know that a
permit is not valid until it has been paid and issued. /!J�
Applicant; Chrvdtuuvi vans I '[/ Ili !S (�( �0 / q/7/i I ¢
Print Name: Signature ll��ff � Jl 1� W Date O
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