HomeMy WebLinkAbout2325 Northbrook Dr - Applications/Air Conditioner - 07/12/2018Fort Collins
Planning, Development, & Transportation Services
Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.27.40 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). ■ 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 O 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 # el57)1-t Date
For ofike use only
.lob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
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Applicant Name Addr City/State Zip Phone
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Contractor Address City/State ZIP Phone
Contractor City of Ft. Collln§Slales Tax # Are you paying taxes here or by report? ❑ Here ! Report
Sates tw number & requ/rcdbyall mn#adom D Are you paying with your trust account?. ■ Yes ❑ No
Is this a residential or oommerdal project? ■ Residential ❑ Commercial
If residential, is it: i Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ 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 ❑ No If yes, you may need to contact Historic Preservatlon
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors; List the company name or Oty of Ft Collin Acense 0
Electrician Plumber Mechanical _ Roofer Other
I hereby acknowledge that I have read this application and state that the above Information is complete and corecL 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: I i
PrintName�J V til Signature Date
Reviefut data M7017