HomeMy WebLinkAbout606 Locust Grove Dr - Applications/Air Conditioner - 06/25/2018Planning, Development & Transportation
. I t% G f281 N College Ave P O Box 580
Or t „ I Fort Collins, CO 80524
,. Phone 970416-2740 Fax 22+6134
i y OVER-TAE-COUNTER PERMIT'S ONE
This application is to be used to apply for the following peands only (check all that apply) Air.Conditioning
0 Dr- nolihon (interior non structural) ❑ Electrical Alteration (not service change) 0 Gas Light Gas Log
--raphng Unit ❑ Lawn Sprinkler 0 Mobile Home replacement 13 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Vendlagon 0 Water Heater ❑ Watet Line ❑ Wood/Pellet Stove (must be EPA certified provide make model and
manufacturer)
Complete all appilcable information on the appiicatlon Incomplete applications will not be accepted t y
b (gO4C �Date
Application #
-
ForolPi'ce use only
Sob Site AC 9pp/r2dJ
Value of constm on (tat)or m eenals, prvnLj
/n'7�
-1"�V
0 �ZA - J�
P ope er Na e
� ���� i Adq
/StaZip
�
Phone
j
Applicant Nam
Address aty/ate Zip
C4 SPORY
Phone
A6.
)3,
Contractor,P,
Address
— - a_ _ _ .6 .
City/Ste Zip
tea. d _ IFAAPI
Phone
Contractor City of Ft. Collins Sales `Pax #
las tst number IsOil l bYau nrs
cnn1mct
Are you paying taxes here or by report? ❑ Here' IgReport
Are you paying with your mist account? 'Yes 0 No
Is this a residential w merdal project? Resldenbal ❑ Commercial 0 Duplex
IF residential, is It single Family Detached ❑ CAndo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
it commercial is it ❑ gank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ itestaurant 0 Other (explain)
Is this building So years cif age or more? ❑ yes i7 No Ify� you mayneed to aontadH/sMrlcPreservadon
If this is for a demolition permit, what year was the building constructed?
Ir visor to 1975 you will neec j an asbestos asw—ment to submlt Wifi th/5 aPP!/wiion
' ' IF lawn sprinider/badcflow preventer must list ilaensed plumber IF first time A/C must list ilaensed eiectxician
subcontractors UstihernmpanynanTeorQtyofF[Col/lnslicense other
Plumbec Mechanical __ Roomer
i tl�diiaan_�--- - _
Ii hereby acknowledge that I have read this application and state that the above Information Is complete ana correct. i agree w
} r.omply with all requirements contained herein and city ordinances and state laws regulating building construction 3 know that a i
I permit is not valid until it has been paid and Issued
Applicant ��}}�� '�'� ,,//�� ',_/�/�{J i
Print NainOV&J _ S'ignatura� ,�C"i � � J. r�� ,