HomeMy WebLinkAbout432 E Drake Rd - Applications/Furnace - 12/10/2014Aire Sery Heating & Air
970-416-6516 PA
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970 416-2740 Fax 224-6134
* 114.00
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply forthefoilowing Permits only (check all that apply)- ❑ Air Conditioning
❑ Demolition (interior nonstructural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
91-leating 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 and
manufacturer).
Complete all applicable Information on the application.
Application #_ �
For nfTiLe on1v u5B OrIIV
incomplete applications will: not be accepted.
Date �2�io/zoo
Job Site Address (requlmatl
Value of Construction Qator, materials, profit)
Property Owner Name Address
MIKE WEEM 29E
City/State Zip Phone
FD Tf19s co gms 3 o-y2
Applicant Name Address
city/State Zip Phone
CUSTOM HEATING INC 395 DELOZIER
DR #120 FORT COLLINS, CO 80524 282-7220
Contractor Address
city/State Zip Phone
SAME AS APPLICANT
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? 53'Here ❑ Report
sales raxnumberls required byall cantracMis.
Are you paying with your trust account? 17 Yes (3 o
31254
Is this a residential orcogIn emal project? [Residential ❑ Commercial
If residential, is it: I Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar 13 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this budding 50 years of ane or more? 0 Yes o If yes, you mayneV tumntatt Historic PreservabVfl
If this is for a demolition permit what year was the building constructed? AZ O
Ifpr/or to 1975, you wi//need an asbestos assessment to submit wrlri this apprrcaftm.
Description of work
*If lawn sprinider/backnow preventer, must list licensed plumber. If first-time A/c, must list ucensea ®eaoaan.
Subcontractors: UstMecompany name orOiyofFtCollinslicense#
Hectridan Plumber mmhanical H-1004 Rader 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 oontained herein and city ordinances and state laws regulating building construction. I know that a
permit is mot valid until it has been Paid and issued.
AppIlPrint Name: ot± MICHAEL WETZBARGE1 ;gnar bane 2 d r'
Print N