HomeMy WebLinkAbout412 LILAC LN - APPLICATIONS - 6/13/2019City of Planning, Development, & Transportation Services
Fyort Collins 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). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
0 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 # ff) � I o L-f (qH Date 06/13/19
For ogre use only
Job Site Address (required) Value of Construction (labor, materials, profit)
412 Lilac Ln. 8388.12
Property Owner Name Address City/State Zip Phone
Pete Lopez 412 Lilac Ln. Fort Collins, CO 80524 8083419791
Applicant Name Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Drive #4 Fort Collins,CO 80524 9704844552
Contractor Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Drive #4 Fort Collins,CO 80524 9704844552
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 0 Report
sales tax number is required by allcontractas Are you paying with your trust account? ® Yes ❑ No
31906
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: 0 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ 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?
Description of work install Mini Splits
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license#
Electrician n/a Plumber Mechanical H1309 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:
Print Name: Amanda Elder SignatureAmanda Elder Date 06/13/19
Revision date 2/0/2017