HomeMy WebLinkAbout3183 Sagewater Ct - Applications/Air Conditioner - 04/17/2018.:Fcity of Planning, Development, & Transportation Services
ort 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 # `�� a �� Date 4J • �1, I
For office use only
Sob Site Address (required) Value of Con�ction labor, materials, profit)
11:
P ner Name Address � CityCS
Zip Phone
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AP
Ilcant Name Address City/State Zip Phone C�
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Contractor Address City/State Zip Phone(
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Contractor CIty of Ft. Colll les Tax # Are you paying taxes here or by report? ❑ Here ■ Report
Sales tax number esrequired by allconbactors Are you paying with your trust account? 6 Yes ❑ No
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: ■ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ hank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes M 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
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed efectrldan.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical M1160,11
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: Il (�(�C -f t/, /yv�C��n
Print Name. l,'lC ���' 1 XM\ L1Signature Date
Revision dace 2fin017