HomeMy WebLinkAbout1119 Lopez Ct - Applications/Air Conditioner - 11/21/2018Nov 21 2018 11:35AM Saran 9706130826
page 1
cityof Planning, D®velop0104 & Trans
Orb odlins Commun' Development portation Services
.-� 2e1 North Colifte Ave nt &Neighborhood Services
Fort Collins, Co W524 Main: 970A16.2740 Fax: 970.224.sl34
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 'Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Heating unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 0 Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applica 1 Infforrm��agan the application. Incomplete applications will not be accepted.
Application #R @—( Ra Ri Vt�'! � Date _ J 18
rw 0Bke use only
lob Site Address (repubeC) Value of Construction (labor, .Iatelals, profit)
�4w o'Q' _1.15'lS el3 din
Property Owner Name Address
111 A n n !1 r rn rnn n r _ �� �P Phone
r r .
Contractor
City/State P Phone
' n i%A A I I A /rI rN A Am A A,� Address ty/state
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report?
Sslesraxrwn*WISreq�,dbya#mnbac om. Are you paying with your trust account'{ Yes e ❑ No rt
Is this a residential or merclal project? Residential ❑ Commercial
If residential, Is it: ngle Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartrnent) ❑ Garage
If commercial, Is it: ❑ Bank O Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
O Restaurant 0 Other (explain)
Is this building 50 years of age or more O Yes)(No Yves, ynt7 may need to contact HLstvrlc Prese wMn
If this is fora demolition permit, what er was the building osnsbucbed?
*If lawn sprinkler/baddiow preventer, must list
Plumber. If first-time A/C, must list 111cansed eleetridan.
Suboontraeto M List dre company name Or CM1 of Colft hc5we #
afttridaoPlums MechanicaL. Roofer other
I hereby acknowledge that I have read this application and state that the above Infomu>tlon Is complete and correct I agree to
comply with all requirements contained herein and city ordinances and that a state Taws regulating building construction. = knowPa mti Is not valid until It has been paid and issued,
B81Wd0n d8W 2A/1017