HomeMy WebLinkAbout730 Butte Pass Dr - Applications/Air Conditioner - 07/23/2018Jul 23 2018 09:22PM HP Fax 9706130826
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- FOrt'CO�LIIiS P/annIn8, 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). )4 Alr Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (nut service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler'❑ Mobile Home replacement ❑ Roofing ❑.Sewer Line ❑ Photo-voltalc
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pe9et Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application.
Application #p� bosq coq
For office rese &*
Incomplete applications will not be accepted.
.. "" '%Wwwqxzw frequffeal Value of consbuciion (labor, materials, profit)
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Property Owner Name Address Gty/State Zip Phone
IRA WR ' I -o� �530
Applicant Name Address City/State ZIP Phone
Contractor Address City/State Zip Phone
m
Contractor City Of F. Collins Sales Tax # Are you paying taxes here or by report? ere Report
❑
Safestax monderBreq�dredbya#wnbac&W,
Are you paying with Your trust account? XYes ❑ No
mial project? '�Q, Residential ❑ Commercial
Is this a residential oW-MquEmily
If residential, is it:Family Detached O Condo/townhome (single family attached) 0 Duplex
(apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ church 0 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? O YesX No byes, you may need H In contact W1Yc PrL MW0n
If this Is for a demolition
permit, what year was a building constructed?
Description of work In
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*If lawn sprinkler/baCkfI w preventw, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the con'aany name or Cty of Ca%w hbww #
Plumber Medranioel Roofer Other
I hereby acknowledge comply with all that I have read this application and state that the above information is complete and correct I agree to
requirements contained herein
and city ordinances and state laws regulating building construction. I know that a
permk is not valid until It has been paid and Issued.
Applicant:
Paint Name: �Q l u l�� l l_ Y� 111W Vgignatu
Revtft n date TMIM 7 V '