HomeMy WebLinkAbout2242 Smallwood Dr - Applications/Mechanical - 11/29/2011Nov 29 11 08:25a Swan Heating and Air
9706130826 p.1
City of
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). f it Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
"eating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement D Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation @"Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all appl' able information on the application. Incomplete applications will not be accepted.
Application # / Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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46LO i 00
Property Owner Name Address
City/State Zip
Phone CI70
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Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone q--7(jl
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Contractor City of Ft ollins Sales Tax #
Are you paying taxes here or by report? ❑ Here
Deport
Sales tax number ssrequired byau,contractors.
Are you paying with your trust account? Erfes
❑ No
Is this a residential or�cwm ercial project? ❑ Residential ❑ Commercial
If residential, is it: CJ'Single 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? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Yprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Ftlrnaci 0- 1♦,LICJf hecJP-'-_ (PI.�C',C'erY'� r�
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors:: List the company name or City of Ft Collins license #
Electrician `Win l% r'o J eS Plumber Me&anical Roofer Other
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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: j A ' ,4%4 � 1�� i ` (� 31
Print Name:��(t �u 1y(� e � Signatures-1_.�,r1 I �^i�o 'y Date I 1 'a 1 d 0 11