HomeMy WebLinkAbout737 Shadowmere Ct - Applications/Air Conditioner - 06/25/2018Clitycif
Fort Collins
Planning, Development, & Transportation Services
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). Cl Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home re
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Woo
manufacturer).
Complete all applicable Information on the applica
Application # �?) I Q )
Aor office use only
placement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
d/Pellet Stove (must be EPA certified, provide make, model and
tion. Incomplete applications willnotbe accepted.
Date
lob Site Address (requlred) Value of Construction (labor, materials, profit)
Q
Gwner Name Address City/State Zip Phone
N I in -
Applicant Name Address City/State Zip Phone Che r �C� YC�
Contractor Address City/S to Zip Phone
` r
Contractor City of Ft. Collin les Tax # Are you paying taxes here or by report? ❑ Here ■ Report
Sales tax number is required bya0 contractors, Nf1 O Are you paying with your trust account?. N Yes ❑ No
Is this a residential or commercial project? E Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ 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 `- UM
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orCly of Ft CollinsIkense 0
Electrician on cc�.l� 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: //�� �n
Print Name: } J� C 0 I 1 i I Signature y jDate
Revisim date MM17