HomeMy WebLinkAbout518 W Laurel St - Applications/Air Conditioner - 06/16/2018 (8)City of
Fort Collins
Planning, Development & Transportation
281 N College Ave P 0 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) El 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 # Nlb10 LACO O.D Date
For ofce use only
06/16/2018
Job Site Address (requmred)
Value of Construction (labor, materials, profit)
518 W LAUREL ST #12
$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
f
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?
17 Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
W Yes ❑ No
26862
Is this a residential or commercial project? 111 Residential ❑ Commercial
If residential, is it ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
G1 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 M No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 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 Collins bcense #
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 KARENA
Print Name KARENA HUNTWORK Signature HUNTWORK
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Date 06/16/2018