HomeMy WebLinkAbout7513 Blue Water Ct - Applications/Air Conditioner - 11/17/2019City of Planning, Development & Transportation
281 N. College Ave P,O. Box 580
F6rl.} Colons Fort Collins, CO 80524
��- Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply),
tAIr Conditioning ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler
obile Home replacement ❑ Sewer Line ❑ 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 #
For ofFce use only
Date
Job Site Address (required)
452 U
Value of Consbtt �� n (labor, materials, profit)
_ .6
roperty Ovane Name
PDrah
Address City/State Zip
Phone l(
Applicant Name
a1 n�Q
ddress City State Zip
-moo
Phone 910
e el
Contractor
Add
ss City/State Zip
Phone CRQ
V
Contractor City of Ft. Collins Said Tax # Are you paying taxes here or by report?
sales tax number is required by all ccntractors,,,SV Are you paying with your trust account?
ikere ❑ Report
RYes ElNo
Is this a residential or commercial project? M Residential ❑ Commercial
If residential, is it: M 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 more? ❑ Yes ❑ No If yes, you may need to contact Historic preserva tion
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed ele:ctrlcian.
Subcontractors: List the company name or City of Ft Collins license#
Electrician Plumber Mechanical-BUNMechanical-BUNA 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: �Date
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Print Name:_ �}C ' 1 1 � 1�1�$Ignature 4
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