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HomeMy WebLinkAbout4315 Mesaview Ln - Applications/Mechanical - 02/05/2014Feb 051408:56a Swan Heating and Air 970-613-0826 PA Fort Collins 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). Alr Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log Cd'I!ieating Unit ©Dawn Sprinkler ❑ Mobile Horne replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation Emater Heater ❑ Water Line ❑ Wood/Peliet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application # Date For oli-xe use only Job Site Address (required) Value of Construction (labor, materials, profit) 1-13I S ff)-c V I e vi Lc� -, 1 U ;�I U C-D Property Owner Name Address City/State Zip Phone C1 i b -„Hcdl 11)-c54V)%e_V,� "- c) y ,Itr-S C)5z Co Z0Co-0nSS Applicant Name Address City/State Zip Phone Contractor Address City/State Zip Phone q-7 0 5GqCrlr+h S+. v I ti C U5'J Z►� 5`c' 7C] Contractor City of Ilins Sales Tax # Are you paying taxes here or by report? ❑ Here M4teport SaiasrarnumGwrsrequrredbya#wnbwctom Are you paying with your trust account? R9 Te-s i 1 No Is this a residential or com I project? I'Residential ❑ Commercial If residential, is it.. angle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? 0 Yes o If yes, you may need to contact Historic Preservadon If this is for a demolition permit, what year was the building constructed? Ifpnor to 1975, you wfl need an asbestos assessment to submit with this application. Description of work 1- tar nc,c e *If lawn sprinkler/baddlow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician. Subcontractors: List the company name or L7ty of Ft Collins Ncense # Electrician 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 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: L Print Name:n f LWNfZ� e Signature,\l� i l l (`7 r_ Date c�' I