HomeMy WebLinkAbout1613 Sagewood Dr - Applications/Air Conditioner - 01/03/2019City of Planning, Development, & Transportation Services
Fort Collin$ Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 Fa)c 970224.6134
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 # SI Ioe Date
r ofce use only
Job Site Address (required) Value of r'�-=+rziction (labor, materials, profit)
11413 uJ� mac. dal f�S l
Property Owner Name Address City/State Zip Phone
1n:�� k 11�135a �c �C,alL�ns Cb ��sas alb- R • �'t l
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
U 2l
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax number& required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential; is its 00 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 SO years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work lacy- ��i
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City 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: \ •,,
Print Name: CQ'� Signature \ ('� i Date 1 I J I
ReNsfon date 2WO17
I
... :: !] �- i i{
.r .: ''KTIF •.�� i`� ..Z ��� 1 a.ri\ _ .. i t
�.)�. .. ti 71 ...
i .I fl�r
1` >
� _fr
.'INK, •' ...
- "- _ __ _.
-..>•.'i •.r�: I �
1
I ICI • .1.. -
.i �
11i � '
oil C,
. 1 1:-f�, ;. F. � �.
i. I' I C. � _ `J •. J ....
I � ':a... .. iJ`:�
:n •..., a.