HomeMy WebLinkAbout631 E Plum St - Applications/Air Conditioner - 06/22/2018PlanvilAq, Development &Transportation
. l f Cr i _ 281 N. College Ave P.O. Box 580
tt Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
O
i � � 131�� PERMITS ONE
This application is to be used to apply for the following permits only (check all that apply). Air Conditioning
❑ DF•.iiolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑Gas Light r Gas Log
C :; eating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Roofing O Sewer Line O Photo voltaic
❑ Ventilation ❑ Water Heater O Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, modal and
Manufacturer).
Complete all applicable
information
aation on the application, incomplete applications will not be -accepted.ccepted.
Application
iCJ 1 C 4 � 3~11 Date 1 r� _ 22 ~I c
For ofica use only
Sob Site Address (squired) Value of Construction (labor, materials, profit)
{ r�
�I State Zip Phone
roperty Owner Name Address I sty/ �` � r • ';, _ �! % { � `��l�L-II �� J 1� . ��(.% G % J �"h,. t` `' C L
Applicant Nan]
Addre s City/State L< 71p Phone .
Address Clty/State Zip Phone
.-
C
oiiti actor City of Ft ollins Sales Tax : Are you paying taxes here or by report? ❑Here
air hunitir srp4uimd by ail contracro s Are you paying with your trust account? Yes
�Di4/� •
is this a i esideritlal r m . �eraal project? esidenLal ❑Commercial
if residenttai, IS it Single Family Deta a ❑Condo/townhome (single Family attached) Duplex
it commercial, is it: ❑ Bank 0
❑ Restaular
is this building 50 years of,agel
if tljls is for a'demolltion perriii
_rr prier tv 1975 you wirl need an
❑ Yes: .P N
year was the,bu
Is assessment fo
:I/Motel ❑ Medical office ❑ Office ❑ Retail
jfyes you may need to contact Historic Preservation
ding caftstruct6d?
Futimit wiM Ols application.
IN lawn sprinkler/backilow preventer, must list licensed plumber. IF first time A/C, must list licensed electrician.
S u bcontractois: List the company nama Or G'•ty of Ft Collins license #
Plumber
Mechanical iioorer Other
i hereby acknowledge that I have read this application and state that the aoove inromauuu u winN c c 4 .� .- 7•-- --
compiy with all requirements contained herein and dry ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
i Print Name � � Signature�
R