HomeMy WebLinkAbout401 Butch Cassidy Dr - Applications/Furnace - 10/28/2011City of
FortCothns
Planning, Development & Transportation
281 N: CollegeAve P.O:. Box 580
Fort Collins, 00 80524
Phone 970-416-2740 Fax 224-6134
This application'is to be used to apply for the following permits only(check all that;apply). EtAir Conditioning
❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) 0 iGas Lighter ❑ Gas Log
❑ Heating!Uhk ❑ Lawn Sprinkler ❑ Mobileflome replacement ❑ Roofing ❑ Sewer Line ❑"Photo -voltaic
❑'Ventilation ❑ Water'Heater '❑ Water Line I❑ Wood/Pellet.Stove (must'be EPA certified,, provide make, model, and
manufacturer).
Complete,all applicable information on the application. Incomplete applicati ns will not be accepted.
N�Vquq
Appli'catlon# Date
i brolflm ae,onh M. 1
3 b ite Address gulrw)
Value of Construction (labor, materl profit)
Property Owner Name
Addres
a/state ap Phone
Applicant Name
Address
Gty/State ZIP Phone
Contractor
Address
City/State Zip Phone
Air Comfort, Inc 150 Rome Court
Fort Collins, CO 80524 970-490-1458
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? Lf Here D Report
Sale tarnurnberIsrequ#Wbyall mntractom
Are you,paying with your trust account? 0 Yes ❑ No
31791
Is this a residential or commercial project? P'Residential D,Commerdal.
If residential, is!it: O !�pgle family Detached 0Condo/townhome (single family attached) 13 Duplex
IrMultifamily (apartment) El Garage
If commercial, is It: ❑ Bank 0 Bar ❑ Church ❑ Hotel/Motel ❑,Medical office ❑'office 0 Retail
11 Restaurant O Other (explain)
Is this building 50 years of lage or more? ❑ Yes ❑' No if ye$ you.mayneed to contact hLls Wc'Preservatlon
If this Is for a demolition permit, what year was the building constructed?'
Ifprlor to 19n, you Will need an asbestos assewment to submit 1 b5 tots aPPAcetlon.
Description of work
*If 'lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time AtC, must list licensed electrician.
Subcontractors: Ust Me canpany mine or dty ofPt CbNlns Ike►m #
8edridan iPlumber Mechanicah H1321 fe Other
I hereby acknowledge that'I have�read ithls,applicationi and state.that the�above Information Is'complete and'correct. I agree to
comply with all, requlrements contalned'herein and city ordlnancesand state, laws :reg ulating,buildingfconstructiom Y:know that•a
permltls not vaild until It has been paid' and,issued.
Applicant:
Print Name(/ ��y�s Signature- Date 1/