HomeMy WebLinkAbout1309 Lory St - Applications/Air Conditioner - 10/09/2018Warming, Developmer t & Transportation
ClityOtf 281 N. College Ave P.O. Box 580
Forlin5 Fort Collins, CO 80524
Phone 97& 41&2740 Fax 22"134
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 #
gM9016
For office use any
Date /G
sob Sft Address (mquhad)_
value of Consbu ction (labor, materials, profit) _
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Property Owner Name Address
CIty/State Zip Phone
Applicant Name Address
Gty/State Zip Phone
Contractor Address
sty/State Zip Phone
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FO .S
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Contrador City of Ff Collins Sales Tax #
Are you paying taxes here or by report? )8( Here
❑ Report
saxes4w nurnbw&requredbyall wnbectam
S%?Y'r4f
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? Residential O Commercial
If residential, is it: Single Family Detached D Condo/tovmhome (single family attached) ❑ Duplex
Murdfarrdly (apartment) ❑ Garage
If commercial, is it: ❑ Bank O Bar O Church 17 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
O Restaurant ❑ Other (e)plain)
Is this building 50 years of age or whore? O Yes O No If yes, yvu may need to contact Hitwk Preservabon
If this is for a demolition permit, what year was the building constructed?.
Ifprdor to 1975, you W11 need an asbestos assessment to submit ntibh this arInlabGon.
Description of work
*If lawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Lat the company name or Qy of R Collins Ik ense 0
Elec�ririarf L� Plumber Medwnical Roofer Other
I hereby adamwledge 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:
Print Nam
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