HomeMy WebLinkAbout5320 Fossil Ridge Dr - Applications/Air Conditioner - 07/18/2018Jul 18 2018 03:59PM HP Fax 9706130826
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APpllcoWn # e � COO SU ti
For afift M avuj•
Collins Planning; Developmen4 & Tran$portavon Services
Community Development & Neighborhood Services
281 North Cage" Avenue
Fort Collins, 00 WW4 Mein: 970A18.2740 Far 970-224.6134
OVER-THE-COUNTER PERMITS OThis applicadon NLY
O Deb to be molitionktterior non-u to �y for the following pornto only (check all that apply). ❑
❑ He ( struc6ural ❑Electrical Alteration (not Air Conditioning
service change) ❑ Gas Lighter 0 Gas LogatIng Unit ❑ Lawn Sprinkler U Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voltalc
❑ Ventilation p Water Heater O Water Line ❑ WoodlPellat Stove (must be EPA oartifled, provide make, model and
mar).
Complete all applicable Infonnation on the eppikuttlon. Incomplete applications wiH not be accepted,
Job SIEe Address ( Value of Construction (labor, materials, profit)
Property owner Name
Address CRY/State ZIP Phone
-..,I � � s
Applicant Name Address —
City/state ZIP Phone
Contractor Address
11111 h 1I11lLUh/l Anti kiun ..nn ..� .._ city/State 21p Phone
CMftCtDr City of F'IL Collins Sales Tax # � Atrrxantirrir,lrraAre you Paying taxes here err by vreport7 Here ❑ Report
�bredbyavicenoec�
Are you PWn9 with Your trust account? Yes 0 No
Is this a ratsidentlal TsmhulWaNdlY
merctal projecx?Reskl p Commercial
�restderttlal, is It: ngle Fantlly❑Condo/hwnhome (single (aPaMneru) O gage , atfed>ed) ❑Duplex
If commercial, Is rc ❑ Bank a liar p church ❑ Hobel/Motel ❑ Medical office ❑ off
tce ❑Retail
0 Restaurant ❑ Other ( in)
Is this building So yraat7a, of ails or more? O Yes No rf yej; ynu may nwd m c>7v wa If Ws Is for a demotRlpn pen
ult, whet year was building corabtrcbed? a On
Description of work
*If lawn sprinkler/baclam preven er, must list Ucensed plumber. If flriltrtirna A
Suboonbacbmr "St Me /C, mtmt list Iip�ed eleetlidan.
y � or c�yo✓Ft A� g
INrunber.
Medranlml._ Roofer Other
I hereby admMledge that I have read this aWk wim and stale that the above infomwtlon Is complete and correct. I agree to
comply with all requirements contained herein and city ordinarces and state IawS regulating building construction. I know drat a
Pwmlt Is tut valid untN It has bewt paid and Irauad.
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