HomeMy WebLinkAbout3730 Kentford Rd - Applications/Air Conditioner - 05/24/2018City of Planning_. Development, & 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) dAir 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 0 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 office use only
Date_S -Z�"Ig
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
05K 3 W IZAiAeW Al ovfl'// 1�0
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
S2 7o z19 2S7
Contractor City of l4t Coilins Sales Tax # Are you paying taxes here or by report? M'Rere ❑ Report
Sales tar number Isrequ/red by all contractors Are you paying with your trust account? ❑ Yes EI'No
Is this a residential or co.Dmprotect? ❑Residential ❑Commercial
If residential, is it Q 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 6"N'-o /f yes, you may need to contact Historlc 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 electrician
Subcontractors Llst the company name or City of Ft Collins license f
Electrician Plumber Mechanical 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 u _
Print Name Signature Date
Revision date 2/612017