HomeMy WebLinkAbout5232 Cornerstone Dr - Applications/Air Conditioner - 06/18/2014Jun 06 2014 03:08PM One Hour Heating & Air 9706634097.
page 4
Fort Collins
Planning, velopment & Transportation
281 N. Coll Ave P.O. Box 580
Fort Collins, CP 80524
Phone 970-41 -2740 Fax 224-6134
OVER-THE-COUNTER P
This application Is to be used to apply for the following permits only (chi
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service chain
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing
❑ Ventilation ❑ Water Heater ❑. Water Line ❑ WoodlPellet Stove (must be
manufacturer).
Complete all applicable Information on the application. Incomplete apply
Application #�?) I L�o 3 1 0 9 Date
For oAfte use only
ONLY
k all that apply). ❑ Air Conditioning
Q ❑ Gas Lighter ❑ Gas Log
3 Sewer Line ❑ Photo -voltaic
PA certified, provide make, model and
itions will not be accepted.
Sob Site Address (required)
Value of Construction
(labor, materials, profit)
5232 Cornerstone Drive
G
oo, eo
Property Owner Name Address
City/State
Zip
Phone
Jeff French 5232 Cornerstone Drive Fort Collins, CO
90528
970-988-7185
Applicant Name Address
City/State
Zip'
Phone
One Hour Heating & Air 487 Denver Avenue
Loveland, CO
80537
970-6634002
Contractor Address
City/State
Zip
Phone
One Hour Heating & Air 487 Denver Avenue
Loveland, CO
80537
970-6634002
Contractor City of R. Collins Sales Tax #
Are you paying taxes
re or by report?
ID Here ❑ Report
Sales tax nwnberIsregwredbya#wnnact=
Are you paying with your
trust account?
M Yes ❑ No
Is this a residential or commercial project? El Residential ❑ Commercial
If residential, Is it: 10 Single Family Detached ❑ Condo/townhome (single farr 'ly 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 ❑ No If yes, you may need 19 conbetfttodcPreservabion
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 appllca ' .
Description of work Replace
*If lawn sprinkler/backffow preventer, must list licensed plumber. If fiat -time A/C, mu list licensed electrician.
Subcontractors: List die company name or City ofR Cofffin Ikeiise �
t]ectridan Plumber Mechanical Other
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 valld until It has been paid and Issued.
Is complete and correct. I agree to
building construction. I know that a
Applicant: Stacey Schmidt ,
Print Name: Signature Date J Date 06/05/2014