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HomeMy WebLinkAbout412 Butch Cassidy Dr - Applications/Furnace - 10/28/2011CitY. of Planning, Development & Transportation 281 N. College Ave P.O. Box 580 fort oWns Fort Collins, 80524 Phone 970-416-2740 Fax 224-6134 This application Is to beused to apply for the following permits only (check all that apply). ❑ Air Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) E1 Gas Lighter ❑ Gas. Log ❑ Heating Unit ❑ Lawn Sprinkler EI' Mobile Home replacement 0 Roofing ❑ Sewer'Une 0 Photo -voltaic ❑ Ventilation U Water Heater '❑ Water Line 11 Wood/Pellet Stave(mustbeEPA certified'provide make, model' and manufacturer); Complete all applicable information on the application. Incomplete appilcati ns will not be accepted. 9 19 1 1 Application # 1� O — Date f b Site Address inquired) Value of Construc i n (labor, materi Is,,profii) u �dPr&&56�PZe1md. o Property Owner Name Addres , O /State ZIP Phone Applicant Name Address City/State ZIP Phone Contractor Address C1ty/State 7Jp 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? IN Here ❑ Report sales. taxnuraberisrequ/rwhyall contractors Are you paying with your trust account? M Yes ❑ No 31791 Is this a residential or commercial project? ®'Residential ❑ Commercial If residential, is,it: ��❑ Ste�' gle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex II rMulkifamily (apartment) ❑ Garage If commercial, Is it: []Bank ❑'Bar ❑ Church ❑Hotel/Motel ❑ Medical office ❑.Offloe ORetall- 13 Restaurant ❑ Other (explain) Is thisibuilding~SO years of age or more? ❑lYes ;❑ No 1fp% you n?ayaeed to contact ly&cdcAtmlbation If ,this is for a demolition permit, what year was the building constructed? 1f pHor to 19n, you Wl/t neeean asbestos assessment to subnrlt tviby this a p/icetion• Description of work *If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, mush listlicensed electrUan.. Subcontractors: Ust the carrpanYhaMe or, Uty of Pt Cblllris Intense 0 6eci ician Plumber Medianicali H1321 Roofer, Other I hereby acknowledge that'I have read #his application andstate-that theabove.Information is complete and',correct. 'I agree to comply with allrequirements containedherein and city ordinances, and state laws regulating building construction. I know that a permit is not valid until 11t,has'been paid and -Issued. Applicant: ` Print.Nam,k f' Y4n �a Signature, Date; © �� Tye -