HomeMy WebLinkAbout415 Butch Cassidy Dr - Applications/Mechanical - 10/28/2011City of
r-oft Co lkins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-41&2740 Fax 224-6134
This application Is to!be used to apply for the following permits only (check all,that apply). O Air Conditioning.
Cl Demolition (interior non-structural), 'O ,Electrical Afteratiom(not service change), '0'Gas Lighter 0' Gas Log
❑ Heatingi Llnit O Lawn Sprinkler ❑ Mobile Homereplacement O Roofing 0 Sewer Line ❑ Photo -voltaic
O Ventilation O Water Heater O; Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and'
manufacturer).
Complete all applicable Information
jonntthe application. Incomplete appli'cati ns�will not be accepted.
Applica on # ?2M 0M L-�'l"� Date, M %
RbrofJioe use on/Y n 6110
Sob Site Address �qulredi
AX
Value,of Construction (labor, mated Is, profit
Property Owner Name 4J,
Address
&�--
Cl /State ZIP Phone
yll�-9/4
44 Ou
din
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.Applicant'Name
Address
City/State 7Jp Phone
Contractor
Address
City/State ZIP Phone.
Air Comfort, Inc 150 Rome Court
Fort Collins,:CO 8052A 9.70-490-14.58
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? IN Herne El Report
salestaxnrn�berlsregali,ed6ya/�rnntractors
Are you paying with your trust account? M Yes UNo
31791
Is thisa residential or commercialtproject? PrResidential ❑ Commercial
If residential, is it: ❑ gle Family,Detached 0!Condo/townhome (singletamilyattached) �❑ Duplex
IfMultifamiiy (apartment), ❑ Garage
If commercial'. is it: ❑ Bank ❑' Bar '❑ Church ❑ Hotel/Motel ❑ Medical' office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of agesor more? 11 Yes ❑ No Ify% you r oyneed to contact Mktor/c.Preservat/on
If this Is fora demolitionpermiit, what year wasthe building constructed?
If priorto,l9.,',S, jrotJ W/11 need'an asbestos assessmwtto su64iit wI i thfsaAD11cet/on. i
Description of work
*If lawn sprinkler/badcfiow preventer, must list licensed plumber. If first=time AIC, must list licensed electrician.
Subcontractors: 11st the co►njowy name or MY of Ft Cb///ns //tense #
Sedridan Plumber Mechanical 111321 Roofer Other
I hereby acknowledge that I have read'this application and state that the above Information ,is eomplete!and correct. I agree to
comply; with all requirements contained herein and, city ordinances and state laws regulating building construction. 1 know that a
permit'is not valid,untilit has been paid and issued.
Applicant: A - Print Nam W41-)r Signature
TYo,�400je 6., b . aw""O&Rt-