HomeMy WebLinkAbout2115 Yearling Dr - Applications/Air Conditioner - 06/24/2015Jun,24. 2015 3:12PM FOUR SEASONS HEATING
No. 8372
P. 3
FCiof
lirt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-624
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 d 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 #__ . 'F) I Isn !" 21 Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
•r . �y
Property Owner Name Address City/State zip Phone
Applicant Name Address ity/State Zip Phone
Contractor Address City/State Zip P ones p 5^y
F&L',&rssfto 7 ! w Y6 0
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ eport
$1,npnm e rs�required by all contractors Are you paying with your trust account? Yes ❑ No
/n
Is this a residential or commercial project? XT Residential ❑ Commercial
If residential, is it; cvcingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑tsar ❑ Church ❑ Hotel/Mobel ❑ Medical office ❑ Office 0 Retail
❑ Restaurant 17 Other (explain)
Is this building 50 years of age or more? ❑ Yes �Cl No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you w111 need an asbestos assessment to submit with this applICOt/on.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/c, must list Ilcensed electrician.
Subcontractors: L/stthe companynameorCltyofFtCollinslicense #
Electrician 1Plumber Mechanical. Roofer Other
LLLeTAA r.
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: �G U�. V �� 04 Signatur iDate [�
01