HomeMy WebLinkAbout407 Butch Cassidy Dr - Applications/Furnace - 10/28/2011City of
&t Colh n
Planning, ,Development,& `iCransportatlon
281 N. College Ave P.O. Box 580
Fort Collins, CO 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). ❑:Air Conditioning
p Demolition (interior non-structural) 0 ElectricalAkeratlon (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 (mustbeEPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the -application. Incomplete applicati ns wily not bs accepted.
Application # W lY I Date
1
Poroff/ce use;only
.1ob
Sob Site Address requlried)%��
1 Value of Construction .(labor, mategrig��ls, profit)Ap
Property Owner Name
CI /State Zip Phone
6,11itl�®5-6'0 ail-9l® .
Ou
sAidrdres
Applicant Name
Address
Gty/State Zip
Phone
Contractor
Address
Gty/State 21p
Phone
Air Comfort, Inc 150 Rome Court Fort Collins., CO '80524 970-490-1.458
Contractor City of'R. Collins Sales Tax #
Are you paying taxes here or by report?
If Here ❑ Report
Sales tax number Is tequIrW by aff contractors
Are you paying with your trust account?
0 Yes ❑,No
31791
Is this a residential or commercial project? PrResidential �❑ Commercial
If residential,is It: ❑,_§Wgle Family Detached; ❑ Condo/townhome (single family attached) ❑- Duplex
[Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank El Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other(explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Yyes, you toy need to contactWoricPtwervadon
If this is for a demolition permit, what year was the building constructed?
.Yprior to 19,1S, you Will need an asbeslbs assessment to svbihit t 0 this application.
Description of work
*If'iawnsprinkier/backflowpreventer, must list licensed plumber: If first-time AjC,.must listaicensedelectrician.
Subcontractors: pst the coonpany name or Oty of Ft 01114s ikkense 0
dH1321ecbidan Plumber Mechanical Roofer other
I, herebyr 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 ordinancesiand state laws-regulatingibuilding, construction. I know that a
permit is not'valid until It has been paid, and: issued.
Applicant: / ar-1
Print Name(_ !!1� �ni � Signature
Date /0/-2"