HomeMy WebLinkAbout1707 Collindale Dr - Applications/Air Conditioner - 04/14/2017City of Planning, Development, 1& Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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 # ?) 1_1 D 1 ON 5 Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
170
Property Owner Name Address City/State Zip Phone
I-16lin I F. e oszr Z40-353- 98
Applicant Name Address City/State Zip Phone
off& wn gsrkd 5. 432 c 1W 0a Tbti,ij q10 20-72-33
Contractor Address City/State Zip Phone
AloK 04rd &f - 43 Ladtv C b SO le 970 , -03
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? X Here ❑ Report
Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes 'KNo
Is this a residential or co mercial project? Residential ❑ Commercial
If residential, is it: MSingle 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 Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Add 2'12_ -}ran Ly- CAnI o Q r 13 SEEL
*If lawn sprinkler/backfiow 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 A Qtlr1e_ Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and cored. 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 II
Print Name: na wV4 Signature Date bG
Revision date 2/6t2017