HomeMy WebLinkAbout3203 Yellowstone Cir - Applications/Air Conditioner - 05/31/2013May 31 13 06:23a Swan Heating and Air 970-613-0826 PA
of
FOCI Collins
Planning, Development ate 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). 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. Incomplete applications will not be accepted.
Application # 151 3a ^ 91
For offm use only o2is. M
Date S 31 I -,Z)
lob Site Address (required)
Value of Construction (labor, materials, profit)
0 ow ne.
Cr
Property Owner Name
Address City/State Zap
Phone 9-74)
5 e SD o
l e laws 0; r ELCodr
L/
Applicant: Name
Address City/State Zip
Phone
Contractor
Address city/state
ty/State Zip
Phone
Sw)an i Air
t-k kOVEI d Co 80J3
2 (ZW76
Contractor Gty of Ft Ilins Sales Tax #
Are you paying taxes here or by report? ❑ Hi�re
Report
salestarnrrmberis n9quired by all aY acWm
Are you paying with your bust account? C3'Yes
❑ No
Is this a residential or c7rfiercial project? ['(Residential ❑ Commercial
If residential, is it El Single Family Detached ❑ Condo/fiwnhome (single family attached ❑ Duplex
O Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑Other (explainy
Is this building SO years of age or more? Yes No If yes, you may need to contact MWorkftservabon
If this is for a demolition permit, what year was the building constructed?
lfpnor to 1975, you will need an asbestx assessment to submit with Ws applkabon.
Description of work
*If lawn sprinkler/badd9ow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname or GtyofFt Colin Gaense #
Ek,cCician Pkuriber Medeanipa Rooter
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 onlinances and state laws regulating building construction. 1 know that a
permit Is not valid until It has been paid and Issued.
Applicant:
Print Nmte: 1 C�C'c signature r Date '� L