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Home My WebLink About518 W Laurel St - Applications/Air Conditioner - 06/16/2018 (7)City of Fort Collins Planning, Development & Transportation 281 N College Ave P O Box 580 Fort Collins, CO 80524 Phone 970-416-2740 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) S 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 # Q)1VD For office use only Date 06/16/2018 Job Site Address (required) Value of Construction (labor, materials, profit) 518 W LAUREL ST #9 $3,030 00 Property Owner Name Address City/State Zip Phone PURA VIDA FTC CO LLC 999 SHADY GROVE RD S STE 600 MEMPHIS TN 38120 970-407-7267 Applicant Name Address City/State Zip Phone Contractor Address City/State Zip Phone NORTHERN COLORADO AIR INC 812 STOCKTON AVE, FT COLLINS CO 80524 970-223-8873 Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? B Here ❑ Report Sales tax number is required by all contractors Are you paying with your trust account? © Yes ❑ No 26862 Is this a residential or commercial project? 121 Residential ❑ Commercial If residential, is it ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex 111 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 0 No If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? If prior W 1975, you will need an asbestos assessment to submit with this application Description of work ADD AC (CONDENSER ON GROUND ALONG SIDE OF BUILDING) *If lawn sprinkler/backflow preventer, must list licensed plumber If first-time A/c, must list licensed electrician Subcontractors List the company name or City of Ft Coffins license # Electrician WIRED ELECTRIC 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 Print Name KARENA HUNTWORK Signature KARENA °p'^ ME HUNTWORK "_ o o."1 M 9 om° 05 Date 06/16/2018 v