HomeMy WebLinkAbout1018 Mirrormere Cir - Applications/Furnace - 12/16/2011C c 11 07:39a Swan Heating and Air
9706130826 PA
Planning, Development & Transportation
City of • 281 N. College Ave •P.O. Box 580
bt oWs Fort Collins, CO80524
�I Phone 970-416-27402740 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
Cl D olition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Heating 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 # 13 1111 0),1 1 Date La ^ 0 0) � � 5• �G
For office use only
]cab Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip
Phone
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Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone Q7O
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Contractor City of Ft. Colli Sales Tax #
Are you paying taxes here or by report? ❑ e Ii34�eport
❑ No
Sa/rs tax number is re0uired by a!/conlraGois
Are you paying with your trust account? GYYPs
Is this a residential or coTipercrat project? residential ❑ 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 ffl.c If yes, you may need to contact Historo Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
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*If lawn sprinklerlbackflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City offt Collins license #
Electridan
Plumber Medranical 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. ) J1
Applicant: 1 1�l (YC >� Date
Print Name:�C1 t^ i 7 v`�� r e � Signature 4