HomeMy WebLinkAbout2237 Moss Rose Ln - Applications/Mechanical - 05/13/201405/13/2014 12:42 FAX 970 686 6087 AMERICAN AIR HEATING INC-* CITY OF FT COLIN 4!1001
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Planning, Development & Transportation
Cityofa% 281 N. College Ave P.O. Box 580
ort Collins =�. Fort Collins, CO 80524
t'I ( Phone 970-416-2740 Fax 224-6134
Illy 70. 09
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). O Air Conditioning
❑ Demolition (interior non-structural) C3 Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing 17 Sewer Line i7 Photo -voltaic
0 Ventilation 0 Water Heater ci Water Line ❑ Wood/Peliet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. incomplete applications will not be accepted.
Application # I Lt 07,3L+3 Date 5-13 -i J4
For off/ae im o* '
job Site Addiress (required) Value of Cor4buction (labor, materials, profit)
Property Owner Name
Soe- i'Grsi^t
Address
S.A A. A.
Gty/Stabs Zip
Phone
S.%
Applicant Name
Address
City/State Zip
Phone
Contractor Uc # Address city/State Zip Phone
lrwrri�4n OtWle,- H-/ M 5-to Cr>�'4t-An by �iF 1-✓in4or, L'0. k055- 970 &9&-(�7f(P
Contractor City of Ft Collins Sales Tax # 5� Are you paying taxes here or by report? t3 Here 13 Report
salsake nLffnbff&fs riedbya#ConbWtOm 393`/1 Are you Paying with your trust account? ZlYes ❑ No
Is this a residential or commercial pro)ed? ErResldential 0 Commercial
If residential, is it: I2rSingle Family Detached 13 Condo/bDwnhome (single family attached) 0 Duplex
C7 Multifamily (apartment) CO Garage
If commercial, is it 0 Bank ❑ Bar ❑ Church 0 Hotel/Motel 13 Medical office ❑ office 13R,etail
0 Restaurant C3 Other (explalp)
Is this building So years of age or more? 13 Yes aft If yes, you may need to curled Hisra& Presenyadw
If this is for a demoiltfon permit, what year was the building constiticEed?
Ypoly to 1975, you w///Ived an asters mere to .wbm/t with this application.
*If lawn sprinkler/baddlow per, must IIA licensed plumber. If first-time A/C, must list licensed electrician.
Subcontrtacctorse U& Me cnmganY name OrU!Y of R 5iWIM 0
Eiectrican n' i lids C& e, qua MwMnW. Roofer Other
I hereby aduwvAedge that I have read this application and state that the above information is complete and cored. I agree to
comply with all requiremerft contained herein and city ordinances and state, Ism regulating building construction. I know that a
permit is not valid until it has been paid and Issued.
Print Name: LSIgnature_--JL dt. O bete