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Home My WebLink About2503 Phantom Creek Ct - Applications/Furnace - 07/12/2013Jul 12 13 10:36a Swan Heating and Air 970-613-0826 p.1 FortCollins Plarugng, Development & Tranq3ort260D M1 N. College Ave P.O- BOX 580 Fort Coffins, 00 80524 Phone M 416-2740 Fax 224-5134 OVER-THE-COUNTER PERMITS ONLY This appl on is to be used to apply for the following permits only (check all that apply}- Air Conditioning ❑ Oe efion [anterior next�tructuraq ❑ Electrical Alteration (not service change) O Gas lighter CI Gas frog eating Unit ❑Lawn Sprinkler 0 Mobr�e Home replacement iJ Roofing ❑ 5eaare:r Line ❑ Photo -voltaic Q Ventilation i] Water Heater D Water l me 1Nooai/Peilet Stove (must be EPA certified, provide make, model and manufacturer)_ Complete all applicable information on the application- Incomplete applications will not be accepted. Application J �l C� "Date rw wo = [Lic wuf Sob She Address (required) Value of Construction (labor, materials, Profit), r � �LJ CGU i>�Y Owne:r Itlarrre Address Ws�e Zap Phone �'t-10 ,C�, (�cg Applicant Name Address aty/stafp- Dp Phone Contractor Address Gt.Y/State zip Phone q-1 b Conbactor arty of Ptboirtns sales Tax # Are You paying taxes here or by report-? ❑ Hqre BIWOrt ages tarnrrmberisrr9rr aY��n�uar Are You Paying with your trust amount? Q'fes ❑ No fs this a resident! I ar al pro}ea tl esiden5aI 13 a omme:ralaE i? Duplex If resider., Ts ib 11 Single Family �e d 0 Condo/dome (sngle family attached) ❑ Muffamfly (apartment) 13 Garage If commercial, is it 0 Hank 13 Bar 0 Church 0 HOtel/MOtei ❑ Medical office ❑ Office ❑ Rebaii 0 Restaurant ❑ offrer(explain) Is this building 5o years of age or more? !7 Yes ifYES, 1ou /myneedto aW7RF&fffCt y n*Cprrservatlnn If this is fora demolition permit what Year was the building constructed? gpmarIa1975, you myneedan asbes &sass umment4 mbmitK 40 dra"5apPr": 3lroax Desc ption of work *If lawn sprinklea/iaaddiow Weventer, must It ftensed plumber. If firstfime AM must list Ifoensed electrician. Suban-M :bUm Lithe aw4panyname arG1yofftC0ldn5lfcense Eie[h'i'''^ Rarmbra• _ Meaiaar&al Reaofer athHr I hereby adenovAedgethat I have read this appUcaUon and sI I that the above Information isommplete and comBct fat tD a tD comply wah all requirements conlaine d herein and city anrmances and stab= laws regulating building construction ow perrnft Is not valid until It has been paid and issued. Applicattb Print Tame: