HomeMy WebLinkAbout731 Blue Mesa Ave - Applications/Air Conditioner - 03/02/2017Planning, Development & Transportation
City of 281 N. College Ave . P.O. Box s80
,fort Collins Fort Collins, 00 80524
Phone 970-416-2740 Fax 22+6134
OVER®THS-COUNTER PERMITS ONLY
This application is to be used to apply for the following pe!irllts only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior nonstructural) ❑ Electrical Afteratlon (not service change) ❑ Gas Lighter ❑ Gas Log
Basing Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Rooflng ❑ Sewer Line ❑ Photo -voltaic
❑ Vendlatlon ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete ail applicable Information on the application. Incomplete appilcations will not be accepted.
Application #1 1 O� " ��� Date
Far office rise only
Job Site Address Nqul4
Valve of CCo_nsrb ct9on (labor, mat-lals, profit) pry
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Property Owner Name
Address
aty/State C Zip Phone
pllpnt Nam
Add
aty/State Zip Phone
MA D
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cor
40indAoity
Address
.. el &✓/�%
Gty%State 7Jp Phone
e
�6fR. Collins Sales Tax #
...., ..
Are you paying taxes here or by report? ❑Here `i Report
vas cv� numberlsiequ6edbyaUmiaaccws
�eAle
paying Are you with your trust account? 4Yes ❑ No
Is this a residential oraorpmerdal project? Residential O Commerdal
If residential, Is it: EYSingle 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 Cl No Ifyes, you may need M aonfadHlsiorlcPresenatlan
If this Is for a demolition permit, what year was the building constructed?
Ifplyor to 1975, you will need an asbe^sWs assessment to subin/t ia/lfr bils app//catlon.
Description of work Prtmnau&- l S�;h os^LkI —
*If lawn sprinkler/beckflow preventer, must list licensed plumber. If first time A/C, must list licensed electrician.
Subcontractors: Ust Me company name or MY of PtGbl/lnsAcensa �
pocbidan Plumber Mediankal Hoofer Other
I hereby acknowledge that I have read this application and state that the above Wonnadon 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 I Y u _ ]
Print Name ,YYYY(,l I'i r �t f1, :Ignature
lte,s A,