HomeMy WebLinkAbout1736 Eastwood Ct - Applications/Furnace - 02/06/2012Feb•06 14208:11a Swan Heating and Air
9706130826 p.1
FCiart 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
l�Heafng Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
/❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # Qin�ornJ O S lOJ Date o� ' o� S a
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address City/State Zip
Phone �11v
C en C::7 t:c� l '
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Applicant Name
Address City/State Zip
Phone
Contractor
Address City/State Zip
Phone G-10
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Contractor City of Ft. llins Sales Tax # Are you paying taxes here or by report? ❑ Here Deport
❑ No
Sale; tax mmberisrequired byall contractom Are you paying with your trust account? 0?1?rs
Is this a residential or corn erciai project? � idential ❑ Commercial
If residential, is it: ingle 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 ErkciTf pes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work l i Y- n GC e r P l cc e m a c1
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: [ls7 the company name or Gty of R Collins license 0
8ectridan Plumber Med anical Roofer Other
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: ^ ( e D� a o �O
Print Name: `voJ_ Signature
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