HomeMy WebLinkAbout2216 Clearview Ave - Applications/Mechanical - 09/12/2012Sep 12 12 07:35a Swan Heating and Air
9706130826 p.1
City of
Fort 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). Ir Conditioning
❑ D caution (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
5ng 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
For af e use only
Date - - i - Z O i Z- 4D
re4l
3ob Site Address Oeqzd
Z ry i e w Ae_
Value of Construction (labor, materials pro
8200
Property Owner Name Address
City/State ZipC
Phone c 0
1 v V 21� r10. Zc in 1l Z Z � 'e
�\
Y V i VJ l lri O V j Z I
c—
- _
L16-7 i H(D
Applicant Name Address
City/State Zip
Phone
Contractor Address
S j- City/State Zip
Phone a --I C5
-A 'a lr -t)CL W•kSUThi LdU-e-" L'o
2ls-5UD
Contractor City of Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here . ErIfeport
motes 0 No
.sares4wnumber srt+4ukredbYammnnarmrs.
Are you paying with your trust account?
Is this a residential or coin.miIcial project? Erl(esidential ❑ Commerciai
If residential, is it Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ 13ar ❑ Church ❑ Hotel/Motel , ❑ Medical office ❑Office ❑Retail
❑ Restaurant ❑ Other (e)Vain
Is this building SO years of age or more? ❑ Yes o If M you may need to contactHisfu is Pneser►2tlon
If this is for. a demolition permit, what year was the building constructed?
Ifprbr to 1975, you wlfl needan asbbestvs as-,;P mentto submit with this appllrabm
Description of work
*If fawn sprirdderlbacidlow preventer, must Ist licensed plumber. If first time A/C, must list licensed electrician.
Subeontractorm List the company name Or City of Ft Cons rxe'Lw
Flarirtrian 1 ul i r\ (c, rr,,s plumber. Mechanical Roofer Other
I hereby acknowledge that I have read the 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. II know that a
permit is not valid until it has been paid and issued.
Applicant:
Name: mYl r � n Print
� �' [� P � Signature
Print