HomeMy WebLinkAbout426 San Juan Dr - Applications/Air Conditioner - 06/11/201306/11/2013 06:57 FAX 970 686 6087 AMERICAN AIR HEATING INC 4 CITY OF FT COLLN 121001
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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). I�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 ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information On the application.
Application # R W 2 E5Yf
For office use only
Incomplete applications will not be accepted.
Date -//- )3
Job Site Address (required) Value of Construction (labor, materials, profit)
��19 .Baal :TL,4r7 ,Ix , 1 $ v`�8 � 5 �
Property Owner Name
Address City/State
Zip Phone
Chr>5 �r Ae,CKc•Canr
SRn 7uevi Dr. F_C.
305,2 .
Applicant Name
Address City/State
Zip Phone
Contractor Uc #
Address City/State
Zip Phone
W- /7,;9 .
5fo ( S 4!ardrF W rdsvr
eo. 805: o 170 G8&-1 0F(1P
Contractor City of R. Collins Sales Tax # :ice Are you paying taxes here or by report? mere ❑ Report
Sale5laxnumberisrequi2dbyallconbactor& 03y0 Are you paying with your trust account? O'les ❑ No
Is this a residential or commercial project? CErResidentlal ❑ Commercial
If residential, is it: ErSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
O Multifamily (apartment) ❑ Garage
If commercial, is it O Bank ❑ Bar ❑ Church ❑ Hotel/Motel 13 Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain)
Is this building SO years of age or more? O Yes Er No If yes, you may need to contact Historic Preseruatfon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit wib4 this appl/cabon.
Description of work � A )C
*If lawn sprinkler/bacldlow preventer, must fist licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors; List the company name or City of Ft Collins license 0
Electrician W r feal a e, plumber Mechanical 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 ail 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.
Print Name: Signature 3 /J Date