HomeMy WebLinkAbout1013 Somerly Ln - Applications/Mechanical - 05/11/20121k,
12 07:46a 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 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
D getholition (interior nonstructural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 13 Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water line ❑ Wood(Pellet Stove (must be EPA certified, provide make, model anck
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # B) ao 6.110
For ofte use only
Date I. 2,Cd 12 Jo.D• DU
Job Site Address (rayuired)
Value of Construction (labor, materials, profit)
Properly Owner Name Address
City/State Zip Phone a--GD
Cr S <5 o rne-o'
L st-n c --� Ct ;11 i n'.s
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone Ct-10
Contractor City of Ft 6611ins Sales Tax #
Are you paying taxes here or by report? ❑ Hssre FMeport
-qwegtxnumberLsra7ukedbya#mn&aarbm
Are you paying with your trust account? ayes ❑ No
Is this a residential or corMmerrial project? E3idential ❑ Commercial
If residential, is it Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office E3 office ❑ Retail
❑ Restaurant ❑ Other (explain /
Is this building 50 years of age or more? IO Yes o If yes, you may need to contact Historic Pnsenratron
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will neied an asbesWs assewnent to submit with this appircatfon.
Description of work f 1.Lrr'Y10-L A-) (' e 5rv-`CL+(f,
*If lawn sprinlderibaddlow pneventer, must fist licensed plumber. If first-time WG, must list licensed electrician.
Subeonbacmrs: LW the company name or GTy of Pt Collins ftaw 0
Dectridan Plumber. Medmrtioi Raafer 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 requWamen s contaured herein and city ordinances and state laws regulating building construction. I know that a
permit Is not valid until k has been paid and issued.
Print Name: m4 N "C i' Signature � Date