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HomeMy WebLinkAbout5212 Madison Creek Dr - Applications/Air Conditioner - 07/01/201407/01/2014 13:56 FAX 970 686 60877 AMERICAN AIR HEATING INC CITY OF FT COLLN U 001 Planning, Development & Transportation CityFlirt Collins N�� /. For N. College Ave P.O. Box 580 -f^ Fort Collins, CO i30524 K ( 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 0 Demolition (interior non-structural) O Electrical Alteration (not service change) ❑ Gas Lighter d Gas Log ❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic Cl 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 # Date For office use only job Site Address (required) Value of Construction (labor, materials, profit) 502 )9 .lad i a6N1 n reaelx. Ix. 1 $ Property owner Name Address City/state zip Phone John lAo-rks 52)2 AW;sb.-J Crook Di-. FC. $ga2g G "D Applicant Name Address City/State Zip Phone Contractor Lic # Address City/State Zip Phone rwwer,P4ot /J/r-AQ, #-/7V S(o 1 C- eardtiry fir•' F Wera`far C0• go5�0 970lo�lo"(��`<P Contractor City of Ft. Collins Sales Tax # -,Fy- Are you paying taxes here or by report? mere ❑ Report S�restrxmmberis egriredbyal�ta„battrns 393y! Are you paying with your trust account? eYes ❑ No Is this a residential orrcommerclal project? CriResidential CQ Commercial If residential, is it: Iff Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it; ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail C7 Restaurant ❑ Other (explain) Is this building 60 years of age or more? ❑ Yes LWNo If yes, you may need to contadH/sta ricPremnedon If this is for a demolition permit, what year was the building constructed? Ifprfor to 1975, you will need an a5ta%Vs omssn t+nt to submit with this appllcatron. Description of work 1��, � A X- _ �yfinrr'r _ *If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-ume A/C, must list licensed electrician. Subcont Jmc'tors: List the company name or Oiy ofFt Call/us license 0 Becftlan �► r reg(a C. piumlrer Mechanical_,_,_ Roafet' Other I hereby acknowledge tttat 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. Printcant Name: � Signature Date J7 %"f