HomeMy WebLinkAbout6570 Rookery Rd - Applications/Air Conditioner - 07/23/2019City of Planning, Developmen4 & Transporiafion Services
Fort CdLins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 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 applyj. ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Dectdcal Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lavin Sprinkler ❑ Mobile Home replacement ❑ Roofing 17 Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #.
LJI"ItS�C)`l 1
For afikerhseoafy
Date July 23, 2019
Sob Site Address (regnuad) Value of Construction (labor, materials, profit)
6570 Rookery Road, Fort Collins, Colorado 80528 $7382.00
Property Owner Name Address City/State ZIP Phone
Carol Penn 6570 Rookery Road Fort Collins, CO 80528 970-397-6692
Applicant Name Address (sty/Stale Zip Phone
Christina Evans 1015 Link Lane Ft Co, CO 80524 4944-7632
Contractor Address aty/State Zipp Phone
Allen Service 1015 Link Lane Ft Co, CO 80524 484-4841
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑Pere ❑ Report
'Wesborwr
br&taqi&Wbya1conftad= Are you paying with your trust account? VYes ❑ No
10010
Is this a resiidential or trial project? V=enfial ❑ Commercial
If residential, is it 'V Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplec
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
is this building So years of age or mare? ❑ Yes ❑ No TfM, you r»yneed tb cxda&htt *PreseWUon
If this is for a demolition permit, what year was the building canstnxted?
Description of Work RMOModsYingACadreO=With�likeAC
*If lawn sprinkler/baddiow preventer, must list 6rnnsed plumber. If first time A/C, must list licensed electrician.
Subcontractors- lattheaompanynameorGlyofftCiAnsfrbmw#
Sectridan Plumber Medhanicdr Roams 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. r + Applicant; Chri�tuha l vavis !1 V 1 i(�11 A m f /tlt�tJr lsL� lahq
Print Name: �gnatvreDate
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