HomeMy WebLinkAbout2012 Leicester Way - Applications/Furnace - 02/15/201302/13/2013 16:32 FAX 970 686 6087 AMERICAN AIR HEATING INC 4 CITY OF FT COLLN 121001
A / Planning, Development & Transportation
Cityof
/�, g a /v�� r // 281 N. College Ave P.O. Box 580
Flirt CoLLI iS 7 • Fort Collins, CO 80524
/ ( Phone 970-416-2740 Fax 224-6134
OVER -TIE -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 0 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 # Y 136b(PC1 S Date _ o? - /3 J3 a'1S
rot, oA9ce use only — - —
Sob Site Address (required) Value of Construction (labor, materials, profit)
o?O 1.';� ze. I ces e.l` ay $ Z! dZ
Property Owner Name
Address
City/State
Zip
Phone
Jk � ^I � »Gib
lm?5 %fin j�r•ici
c �, W ;
se6 �OSSO
3-93 O
Applicant Name
Address
City/State
Zip
Phone
Contractor Lic #
Address
City/State
Zip
Phone
ilwerti4ny/rAli 39.3411
5(ot f: Warden�r.�
h/rndSor
eo• 8oS�0 9706,b'6,-Lv0F(e
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? mere
❑ Report
5alwtwnumberISrequiiedbyanconbadivs- "1
Are you paying with your trust account? des
❑ No
Is this a residential or commercial project? CkResidential ❑ Commercial
if residential, is it: L3'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 If yes, you may need W contact H/stork Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you w111 need an asbestos assessment to submit wi(h this applicatGon.
Description of work ro�cq _ rnnce
*If lawn sprinkler/backfbw preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors. List the company name or Gty of Ft Colons license 0
Eectridan rr 1 �6�14 L C. Plumbs Medwniml 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 consmicdon. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: "'fir, l/ Signature/YI Data 2
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