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HomeMy WebLinkAbout2401 Poplar Dr - Applications/Mechanical - 07/18/201307/18/2013 12:03 FAX 970 686 6087 AMERICAN AIR BEATING INC 4 CITY OF FT COLLN 1a001 FCity Of 6.rt Collins Planning, Development & Transportation 281 N. College Ave P.O. Box s80 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). F Air Conditioning ❑ Demolition (interior non-structural) © Electrical Alteration (not service change) 0 Gas Lighter Cl Gas Log ❑'Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 0 Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodiPellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application #Rol At IF Date rbr oh9Me Job Site Address (required) Value of Construction (labor, materials, profit) 9*0 / PERISE Ds-. � 72 7S Property Owner Name C;nci VAfCe- Address ��a/ Po %r City/State Dr. >�ort ColJ,ws Zip Phone SCS."t� 53a�03e5 Applicant Name Address City/State lip Phone Contractor Lic # Address City/State Zip Phone Alrxrriccvt A & #-/ M 5k 1 C W,rdSor, L40. 905L-0 97o lohYo-1��� Contractor City of Ft. Collins Sales Tax # 393�// yj= Are you paying taxes here or by report? mere ❑ Report saAastarntmbw,i-r&quuedbyal/mnb CftW. Are you paying with your trust account? des 0 No Is this a residential or commercial project? a'kesidential ❑ Commercial If residential, is it: S�Single 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 arho If yes, you may need to contact H/stor/c Preservatlon If this is for a demolition permit, what year was the building constructed? Yprlor to 1975, you will need an asbestos aswssment to subm/t with thls appllcatton. Description of work _ 1 �1� Fkrn,� * A X *If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors; List the company name or Oty of Ft Calms 11cersse 0 Oedrician Y► g l-e/4 L e, Plumber MechaMpl Roofer other I hereby acknowledge that I have read this application and state that the above information is Complete and correct. I agree ho Comply with all requirements contained herein and city ordinances arid state laws regulating building construction_ I know that a permit is not valid until it has been paid and Issued. Applicant Print Name: v'�r �� Signature '► /�e.�_ Date 7J/