HomeMy WebLinkAbout6112 Brookwater Ln - Applications/Air Conditioner - 04/23/2018PlanniA9, Development & Transportation
—ICY O _ � 281 N, College Ave . P.O. Box 580
Fort Collins; CO 80524
Phone 970 416-2740 Fax 224-6134
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This application is to be used to apply for the folloiiyirig peRnits anly (check all that apply). Air Conditioning
Da• ,olition (inferior non-s£ructural) ❑Electrical Alteration (not service change) D Gas Lighter ID Gas Log
t ,eating Unit Q Lawn Sprinkler El Mobile Home replacement ❑Roofing El Sewer Line 0 Photo -voltaic
❑ Ventilation, ❑Water Heater ❑ Water Line ❑ Wood%Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete ail applicable information on the application. Incomplete appiicatioris will not be accepted.
Application •#
01 �b 5�`bs Date 1� 43 -
FAr office use only
-777-7777-7777777 3ob Site Address (i?qu/redJ Valve of Cogistruciioa� (labor, materials) profit)
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Property Owner Name Address City/Stet Zip / Phone
ApplicanC Nani@; Ad
;
s J City/State Zip Phone
T�m Van
om— City/State 7�p Phone
Contractor Address
No
Conte actor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? ❑Here i RE
„ram:.., i,u127au•cs4ouiredliYagmntra2fors Are you paying with your trust account? `Yes ❑ Nc
L
Is this a residential o m Zieraal project? esident�ai ❑ Commercial
reeidenual, is it: Single Family.Detachej ❑ Contlo/tow_ntiome (single family attached) ❑Duplex
i ❑ . ultifamily (apartrnerit) ❑ Garage
j if commercial, is it: ❑Bank Bar ❑ Church ❑ Hote_I/Motel ❑ Medical office ❑Office ❑Retail
{]
Cl Restaurant 0 Other (expia(n)
Is this building go years 4a6o or more? q Yes ❑ No. ifyes, yu omayneed to contact HrstoricPreservation i
If this is for a degaofitton permit, what year vwas the building bofst'ua6d?
dfPiior tri i975 you writ need an as, assessment to stibmrt with this ePPI/cation• i
"`If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Ure company name or Oty of Ft Collins license
� L'Ixtiician_: —
Plumber Mechanical Roofer t
r hereby aciaiowledge that I have read this application and state that me aoove uuui ❑wu-n - u,l w u �•, _- _ -- --
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.
App;icant: 'ran • ofSignature.-
Print Name.,`_ y , _ — SI natures