HomeMy WebLinkAbout4555 Seaway Cir - Applications/Air Conditioner - 05/30/2014May 29 2014 09:26AM One Hour Heating & Air 9706634097
page 2
City 0f
Fort Collins
OVER-THE-COUNTER
Planning, DinreloPiment & Transportation
281 N. Coll Ave P.O. Box 580
Fort Collins, sU524
Phone 970-4 2740 Fax 224-6134
This application Is to be used to apply for the following permits only (che
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service than!
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pallet Stove (must be
manufacturer).
Complete all applicable Information on the application. Incomplete appih
Application # R 14o &!;A Date
For ol9ibe use only
ONLY
all that apply). ❑ Air Conditioning
❑ Gas Lighter ❑ Gas Log
Sewer Line ❑ Photo-voitelc
A certified, provide make, model and
will not be accepted.
Sob Site Address (required)
Value of Coin
struction (labor, materials, profit)
4555 Seaway Circle
$5,530.00
Property Owner Name Address
City/State
Zip
phone
Jennifer Muller 4555 Seaway Circle Fort Collins, GO
80525
970-412-3186
Applicant Name Address
City/State
Zip
Phone
One Hour Heating & Air 487 Denver Avenue
Loveland, CO
80537
970-663-4002
Contractor Address
City/State
Zip
Phone
One Hour Heating & Air 487 Denver Avenue
Loveland, CO
80537
970-663-4002
Contractor City of Ft Collins Sales Tax #
Are you paying taxes t
ere or by report?
M Here ❑ Report
-qye' iax^wgiea req&rW by a/ oon"crom
Are you paying with yc
ur trust account?
® Yes ❑ No
Is this a residential or commercial project? El Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical t
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yres, you fnayne
If this is for a demolition permit, what year was the building constructed? _
IfPrw to 1975, you will need an asbestos assessrnent to submIt wfAh this annllt
Description of work
*If lawn sprinlder/backflow preventer, must list licensed plumber. if first-time A/C, n
Subcontractors: List the company name orCRyofRCoNnslKeruie #
Baclt^cian plumber Medianical
I hereby acknowledge that I have read this application and state that the above it
comply with all requirements contained herein and city ordinances and state laws
permit is not valid until it has been paid and Issued.
Applicant:
y
ranApplicant:rrt Print State Schmidt St�ue�y
Name: Signature
attached) ❑ Duplex
❑ Office ❑ Retail
CoMact HLsfonc Preservatron
list licensed electrician.
Other
Is complete and correct. I agree to
building construction. I know that a
Date 05/29/2014