HomeMy WebLinkAbout3600 Swanstone Dr - Applications/Air Conditioner - 07/05/2019Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 # (_�C6`IU C4 Date -1-519
For offce use only
Sob Site
rr,^Addres`�I'(r1equired) r
Value of Con truuction (labor, materials, profit)
Pro I rty gynerName Address
City/State Zip Phone
Applicant Name Address
City/State Zip
Phone
Contr or Address
City/State Zip
Phone C 10 —
S
Contractor City of Ft. Collins S es Tax #
Are you paying taxes here or by report?
® Here ❑ Report
Sales tax number is required by all contractom
Are you paying with your trust account?
❑ Yes ® No
Is this a residential or commercial project? O Residential ❑ Commercial
If residential, is it: O Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant' ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname or City of Ft Collins license #
Electridan Plumber Mechanical 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: "�% -Ij jq
Print Name: Signature Date t J h l
913
7,41 12