HomeMy WebLinkAbout4714 Prairie Ridge Dr - Applications/Air Conditioner - 04/17/201505/06/2015 08:53 FAX. 970 686 6087 AMERICAN AIR
Flirt Collins
HEATING INC
IM 001
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Pax 224-6134
OVER-THE-COUNTER PERMITS ONLY /
This application is to be used to apply for the following permits only (check all that apply). li3'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 C3 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all a pli tale in orrr iki� n he application. Incomplete applications will not be accepted.
Applic o fad Date
E��17 W5
-for cluck JLW only
So��b�Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip Phone
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Pre'W;e_ J)e. F-C • '3*;14 556
Applicant Name
Address
O /State Zip Phone
Contractor Uc #
Address
City/State Zip Phone
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(er, �r.'1F Wrrdyar, 4to- �aSZO q70 100
Contractor City of FL Collins Sales Tax
Are you paying taxes here or by report? mere Cl Report
saiesraxrumbe� �.equradbyancwrtraatws '39'�`f!
Are you paying with your trust account? des ❑ No
Is this a residential or-o9mmerclal project? f.'9"Residentlal ❑ Commercial
If residential, is it: 0 Single Pamily Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
Tf commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 17 Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? D Yes UrNo If yes, you may need to contact Hlslvrtc FmoriaVon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1974 you will need an asbestras assessment to submit with this application.
Description of work
*If lawn sprintder/backflow preventer, must list licensed plumber_ If first-time A/C, must list licensed electrician -
Subcontractors: W Me company name or ®ty ofR Colfigs license 0
Bectriclan W 7 l,d a e. Plumber MediariKal 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.
Applicant:
Print Name: lr4illre </ Signature , - Date
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