HomeMy WebLinkAbout1000 Mirrormere Cir - Applications/Air Conditioner - 02/20/2018PlannIA9, D-evE9opfnent & Transportation
I i 107 r.� 281 N Ooilege Ave _ P.O. Box 580
4 Fort Collins, CO 66524
-o. Vie... . fiR.
Phone 970-416-2740 Fax 22+6134
ONL
OVE
iOm '.NTER PERMITS ON
This. abplicaoRn is to be used to apply forthp following perrnkts oT.
nly (checiCai3 that apply Air Conditioning
V Q*..:,olition (interior 6667structural) [IElectical Alteration (not setvlce change) O Gas Lighter ❑ Gas Log
❑S , piing Unit O Lawn Sprinkler O Mobile Home replaceMent p Roofing ❑ Sewer Line. p Photo -voltaic
❑ Ventilation. p Water Heater Water Line ❑ WooId/Peliet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all aVFbuse
tl n Vaanplication. incorirplete appllcatlons will not be accepted,
Application # Date ��1�7
nly
Sob Site Acidness (r2qu/r2dJ Value of Coris izon 1.(labor, materials, �� )
Pi operty Owner Na a Address City/ e Zip Phone
1 s�►u. 7o 2(�- 5.
dr
Apptican nN.!
City/State Zip Phone
T i,an� CIDxb%q 170- {- -v
Contractor r Address Cit7f/State �� Phone_
Contractor Gty of ,Ft Collins Sales lax # Are you Raying taxes here or by report? ❑Hera Report
lw.—'Mtn---1:isi.,--ret6y'aimntractors Are you paying with yourtriistaccount? (es ❑No
Is this a residential or c mmi . clai project? deril al 0 Commercial
IF iesidendal, is it: 1n81e FamdyDetached, ❑ Condo/townhome (single family attached) ❑Duplex
Cl Multifamily (apar¢nent) ❑ Garage .
j If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
l ❑ Re_siabi-Ant ❑ other. t6 p airi)''
Is this bwlding 50 years of.ago or more? ❑ Yes O No. Ifyes youmayneed in conbctHistoricP2sanadon
If this is for a o!an'01tion. permit, v,rtiatyear.was thq bull ing 9R., cted?.
rfF�iiur tv 1975 you will need ah asbe tos ass�ssmentCo submit wib5 thrs applTiation.
Description of work RO rb__ Nd—
"`If lawn sprinkler/backflaw preventer, must list licensed plumber. If fiist time A/C, must list licensed electrician.
Subcontractors: List the company name or Litt' of R Col/ins license 9
t
/ 1 \` _anical Roofer Other
t tlecpi�ian`�^` e.q'1r�Plumber. Mech
r hereby acknowledge that I have read this application and state that the above information is complete and correct I agree to t
Comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is notvalid until it has been paid and issued.
I Applicant: I an_,. Signature . H- �� L�
i Print Name.. r