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HomeMy WebLinkAbout2912 Teal Eye Ct - Applications/Air Conditioner - 11/14/2018��C'ity°f Planning, Development, & Transportation Services Oit 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 a[[ that apply).vQfAir 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 # a � -` u ©0 W For office use only Date November 14, 2018 Job Site Address (required) Value of Construction (labor, materials, profit) 2912 'rM&Ey&C0art; F0rtC0UiU , CO 80526 $5497.00 Property Owner Name Address City/State Zip Phone Ia iW''8avbcwa,Montvg 29127`ea&Eyact Fort Colltn%Co 80526 970-226-6927 Applicant Name Address Clty/State Zip Phone ChriWwwL,i va ry 101 S LCr&. La,Le Ft CO; CO 805L 494-7632 Contractor Address City/State Z[pp Phone cz AUe vSe,rvt101 S LCnk.Lan& Ftco; CO 80524 484-4841 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑Mere ❑ Report Sales tax number isrequiredbyallmntraaors. Are you paying with your trust account? 14Yes ❑ No 10010 Is this a residential or qpmmercial project? Residential ❑ Commercial If residential, is it: V 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 morel ❑ Yes ❑ No If yes, you mayneed to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? Description of work Rive, Ag-AC an&rep4w.&jurtivnew Uk&AC *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the companynameorCity ofFtCollins Ccense# 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. Applicant: GhyLbtTv:a Evany h&ry�Print Name: Signature �un Date 6 Revia;on date W620V