HomeMy WebLinkAbout424 W Myrtle St - Applications/Air Conditioner - 07/11/201807/11/2010 2:41PM FAX 9704844373
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Planning, Development & Transportation
Cityof281 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). ❑ 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). i 1-�'7, x7
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #br� J 49 Date 0 �,
For offike use only
Sob Site Address (requ/red) Z4 VY. JV Igr r -
Value of construction (labor, materials, profit)
m Ur 4s-4
01o - o-1 5
Property Owner Name Address
City/State Zip Phone
Full ebl Grp �52! q7o /�o-1ro75
Applicant Name Address
City/State Zip Phone
l' r V r) -!
Contractor Address
zip Phone
City/State l
1=ot--I-• Col��ns
&ACk a
to r 9 ' Ii
Contractor City of R. Collins les Tax #
.10
Are you paying taxes here or by report? ❑ Here Report
Sales tax number is required by ad contractors
Are you paying with your trust account? JQ Yes ❑ No
Is this a residential or commercial project? Wkesidential ❑ Commercial
If residential, is it: .40 ingie Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank 0 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
0 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? Dyes Ail -No If yes, you may need to contact Histanic Presetvatlon
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 apphcab`on.
Description of work KWAeb bra rV 6Lu,. At+
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name of City Of Ftt:ollinsliCense-0
Electridan Plumba Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correcL ' 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: V- n/�
Print Name: � + iT� �t / Signature �' - V v"�`" Date ( U