HomeMy WebLinkAbout6120 Tilden St - Applications/Mechanical - 05/10/2012May 10 12 08:12a Swan Heating and Air
9706130826 p.1
of
Flirt Collins
Planning, (Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 97D-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
❑ 17olition (interior non-structurao ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O 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 # vI2�2� Date Q • I �--.
Forofte use only
Job Site Address (require)
Value of Construction llaatmr, materials, profit)
Imo" 1 1. 5�-
`WQ� ;�
Property Owner Name Address
City/State Zip
Phone
Ot-7C,
?-c-) -.-
SCo I C. M
-7 N
- 1ACH
Applicant Name Address
Gty/state Zip
Phone
Contractor Address
City/Stage Zip
Phone
q`Ip
UAen 1k, Lzvil" ft) J3%
Zt •
-h0
Contractor City of . Collins Sales Taos #
Are you paying taxes here or by report? ❑ H
eport
Sa/esbrnon2berkregLdredhyabmntractom
Are you paying with your trust a000unt? & es
❑ No
Is this a residential or co3pwfdal project? 62'hesidential ❑ Commercial
If residential, is it; GMngle Family Detached ❑ Condo/tuwnhome (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 ffyes, you may need to mntadHistwcAleServabon
if this is for a demolition permit, what year was the building constructed?
Ifpttiorrto 1975, you will need an asbestos asses u ntto submit with this applimtlon.
Description of work
V lawn spdnkler/baddiow preventsr, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ltst the cmpany name or Lfty offtCollUrs!lcume #
KffdXr. Med,anikal Roofer Outer
I hereby acknowledge that I have read this application and state that the above Information is complete and correct. I agree to
comply withal requirements contained herein and city ordinances and state laws regulating building construction. I (mow theta
permit is not valid until it has been paid and issued. K)i CLg
Applicant;nt i 1
PrinttName: Q(� NCnC`'Q-i Sig _ nature�� ' Date S1 U' 2-0 iZ.