HomeMy WebLinkAbout3706 Ashmount Dr - Applications/Air Conditioner - 07/17/2018�City
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Manning, (Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, 00 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following pertnfls 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).
Complete all applicable lnfoqnation on the application. Incomplete applications will not be accepted.
Application #90 Date
for use only
.lob Site Addn>m (requhed)
Value of Consbrucdon (labor, materials, profit)
Pro Owner Na Address
City/State Zip
Phone
-
-/�
Applicant Name Address
City/State Zip
Phone
Contractor Address
aty/State Zip
Phone
Contrador City of Ft Collins Sales Tax #
Are you paying taxes here or by report) )8( Here
❑ Report
.saxes 4t�w�r nwnber is repuved by a0 arrbacYas
Are you paying with your tent aeoount? ❑ Yes
❑ No
Is this a residential or commercial project? Wesidentiai ❑ Commercial
If residential, is it: Single Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
MultlfarrdN (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 0 No If yes, yrw may need to contact HisiWc Piesewbbn
If this is for a demolition permit, what year was the building constructed?
Ifpnbr to 197_,, you rvlll need an asbestos ozesurmt to subnot winl Mls aPp&wtron.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Suboonlsactors: List the company name or O?y of R Collins Ikense 0
i]ectrida& & aze PlumberMechankaf 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:
Print Nam
Date
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