HomeMy WebLinkAbout2115 Yearling Dr - Applications/Air Conditioner - 06/24/2015 (2)Jun,24. 2015 3:11PM FOUR SEASONS HEATING
No. 8372
P, 2
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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Q 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 applicable information on the application. Incomplete applications' will not be accepted.
Application # &J50+11G1• Date r�yl1:1__
For offlce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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property Owner ame Address
City/State Zip
Phone
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Applicant Name Address
City tale Zip
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Contractor A dress
City/State Zip
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
4' &re ❑ Report
sal x mbe I requlredbyallmnUactors:
Are you paying with your trust account?
0 As ❑ No
Is this a residential or commercial project? 04widential ❑ Commercial
If residential, is It: 1(Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes 3T No If yes, you may need to contaetHlstorlcPreserwdon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this appllcation.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license �O
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.
Applicant: QL
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Print Name: •U7� Slgna u^ . Date
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