HomeMy WebLinkAbout3201 Kechter Rd - Applications/Mechanical - 05/16/201305/16/2013 07:05 FAX 970 686 6087 AMERICAN AIR HEATING INC i CITY OF FT COLLN la001
City of/�; Planning, Development & Transportation
G L 281 N. College Ave P.O. Box 580
Fort Collins !7 Fort Collins, CO 80524
Phone 970-416-2740 Fax 221-6134
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) 0 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voftc
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all appy ble information on the application.
Application # __. Ist 7-10 239 s
For off/ce use only
Incomplete applications will not be accepted.
Date )3
Sob Site Address ilrtequ/red) Value of Construction (labor, materials, profit)
320/ /fecA $ LQ '; 5 `�
Property Owner Name Address
City/5tate Zip
Phone
L.eopWut I Junk V)7 Irech4dx- F'al •
I".'C. V $
,=Z. --3d5lp
Applicant Name Address
City/State Zip
Phone
Contractor Lic # Address
City/State . Zip
Phone
rrKrr`Car2 y r */ 72 7 56 t L eorden
�r. *F wtn4ar, Lr0• 9a.5:50
6,96_4m;)F,�
Contractor City of Ft Collins Sales Tax # +Are you paying taxes here or by report?
mere ❑ Report
sales tax numberisrequlredbyaffcvn= ors 3931f/
Are you paying with your trust account? des ❑ No
Is this a residential or commercial project? If Residential ❑ Commercial
If residential, is it: ErSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 13 Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ONO If yes, you may need to cnnta& Hlstnrlc Preservation
If this is for a demolition permit, what year was the building constructed?
If pr/or to 1975, ymu will need an asbesWs assessment to submit wilt this applica ion.
Description of work R,,n1Acz. r%&rnaac -, A 1C-y wAer Pea1C;e-
*If lawn sprinkler/baddtow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: 4iSt b4e company name or Oty of Ft Collins license #
Electridan �l p le� G e, Plumber Medhanical _, Roofer other
I hereby acknowledge that I have read this application and state that the above information is complete and coned- 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 I / -7 / !
Print Name: '2' / G�u'/ gignature
Date -5 --J4,