HomeMy WebLinkAbout1408 Fuqua Dr - Applications/Air Conditioner - 01/27/2017Planrift, Development & Transportation
City Of 281 N. College Ave P.O. Box 580
.,Port �Collins FortC011ins, CO 80524
Phone 970-41616-2740 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). C9'Alr Condftioning
❑ r amolifion (interior non-structural) ❑ Electrical Alteration (not service change) _ ❑ Gas Lighter ❑ Gas Log
L ,seating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellef Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. incomplete applleatlons will not be accepted.
Application # Hate 2-7 —11
a...� .rtia ruJv
lob Site Address (r2yu/sect).
Value of Construction (labor, materials, prop
1 bT (=!Ltc� r
F6co os2 5 M0r-
property Owner N.jme Add
Icl �..f,�
CJty/State ZIP Phone
-3 37��tg3
pllc�nt Nam Address
Gty/State Zip Phone_
tC
D
Cogtractot Address
City/State Zip Phone
Are you paying taxes here or by report? ❑ Here ' Report
contractor Pity of Ft Collins Sales Tax #
Are you paying with yobr trust account? Wes ❑ No
_,Ista� numtierisrrquh�+ibyello�ntractwi
l �R�11
Is this a re;gldentlal or co aerial project? esidential d Commercial
if residential, Is it: single Family Detached ❑ Condo/townhome (single %mlly attached) t7 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotol/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes . ❑ No Ifyes, you mayneed to mntactH/5t0rlcPfese1va6'on
If this is for a demolition permit, what year was the building constr abed?
.rfpdo� to 1975, you w/11 need an asbestos assessment to subm/t iv/th Nris app//raUon.
Description of work—Rknfi_o�fin C v- aw9, hnal�l nnw C tJn%i�
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: LLstthe con rpanyname of6tyofFtCollins 11amse #
0echidath
Plumber Mechanical Roofer other
f 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: 1 /1"r Y I� �C. I'? - 1-7Print Name Lin k Yi•signature._ Dnte --