HomeMy WebLinkAbout4913 Clarendon Hills Dr - Applications/Air Conditioner - 09/14/2018FliCity of planning, Development, & Transportation Services
rt 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). �6kir 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 ❑ 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 # 0 /N0 5 3 Date _
for of ice use only
]ob Site Address (required) Value of Construction (labor, materials, profit)
\ 3 9-1
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
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? 53-lere ❑ Report
S
ales tax number isiequiredbyall mntratYors Are you paying with your trust account? des ❑ No
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Is this a residential or commercial project? 4Residential ❑ Commercial
If residential, is it: Ingle 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 Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or O'ty of Ft Collins license #
Electrician 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.
Applicant: , l
Print Name: ���p\Q a�Q�� Signature �p�,9 ��`f3� Date
Revision daw MOW
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