HomeMy WebLinkAbout3407 Stover St - Applications/Air Conditioner - 10/11/2018Oct 11 2018 12:37PM Swan 9706130826 page 4
wCity, of Planning, Development & Transportation Services
C
� hns Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 50524 Main: 97DA162740 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).)) 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 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 # e I "buci Ua 1 i f�� ' Date
For ofte use only g I Qj 0 1102 4) C.
Job She Address (required) Value of Construction (labor, materials, profit)
3u AN So
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor city of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
Sales tax number tsrequneabyall mntmaVs Are you paying with your trust account? XYes ❑No
Is this a residential or commercial project? *esidendal ❑ Commercial
If residential, is it: 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 (ex)ain)
Is this building 50 Vears of age or more? Cl Yes TA No If yes, you may need to contactHistor/c Preservation
If this is for a demolition permit, what year was the building mnsti ucted?
Description of work
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L/st the c"pany name or Cty of Ft Collins license #
Elect ician Plumber Mechanical Roofer Other -
I hereby acknowledge that I have read this application and state that the above information is complete and corecL 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
Print Name: Signatu Date
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