HomeMy WebLinkAbout901 Grouse Cir - Applications/Air Conditioner - 07/03/2018City0
Fort Collins
Planning, Development, & Transportation Services
Community Development & Neighborhood Services �(�
281 North College Avenue -
Fort Collins, CO 80524 Main: 970.416.2740 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 ❑ 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 # Date
For oHrre use only
Job Site Address (requred) ValueConstruction (labor, materials, profit)
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Property Owner Name 1 }r Addr City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
Contractor City of Ft. Collin les Tax # Are you paying taxes here or by report? ❑ Here ■ Report
Sales tax number isimuimd by all avbwctom Are you paying with your trust account? ■ Yes ❑ No
Is this a residential or commercial project? ■ Residential ❑ Commercial
If residential, is it: ■ 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 preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or city of Ft Collins license #
Electidan Plumber Mechanical 'tc�l_ 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 Namer n V m -71
Signature paw
Revisiw date 29rH117