HomeMy WebLinkAbout6300 Victoria Rd - Applications/Air Conditioner - 06/20/201206/20/2012 14:29 FAX 970 686 6087 AMERICAN AIR HEATING INC 4 CITY OF FT COLLN IRj001
Planning, Development & Transportation
City off ! / 281 N. College Ave P.O. Box 580
Fort Collins r �" 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
* Demolition (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 applica information on thle application. Incomplete applications will not be accepted.
Application # �OQU �J� Ct "1 Date 4,- ,2o - it
For office use only
Job Site Address (required) EValue of Construction (labor, materials, profit)
(,e3oo Vicfor;0. Rd. 5��0
Property Owner Name Address
city/state Zip Phone
ltJ;�},eJle Trace- 606e)
V;c�or;a Ref. Jl�'C, p �25 .223-• 5798
Applicant Name Address
City/State Zip Phone
Contractor Lic # Address
City/State Zip Phone
7PNE,t-1 ',wt yip 94- 3 9 3 41/ 641 F 14-'AI'deM �✓. #F winKJSor L goSls o 97v 69& &0?40
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? here ❑ Report
z)ifftar numbwifrequited byall conbacawy
Are you paying with your trust account? des 1 ❑ No
Is this a residential or commercial project? & Residential ❑ Commercial
If residential, is it: 19 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
O Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel O Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
is this building 50 years of age or more? 13 Yes M'No If yes, you may need to contact HistoricPreser✓adon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit wide th/s appllcat/on.
Description of work Add A 1 r— 74o exls�i�x
*If lawn sprinkler/badd9ow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontra/c'tors:: Ust the company name or Cty of Ft Collins license #
eecwclan L�r r �WEe e , Plumber Mechanical 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.
Print Name: �'`� kjl3vr V Signature �„ ,g'4 pate t° --20 -12