HomeMy WebLinkAbout5950 Fossil Creek Pkwy - Applications/Air Conditioner - 06/16/2015city
Flirt Collins
of
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
❑ 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). (0
1
Complete all applicable information on the application. Incomplete applicationswillnot be accepted. 15,
Application # bl oszro I. Date Wile 11 :1
For office use only
Job Site Address(required)
Value of Construction (labor, materials, profit)
, D
operty Owner Name A ress
City/State Zip
Phone
MP
-R A
r�ss2,
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?
12"H—ere ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes EHVI
31254
Is this a residential or commercial project? Rokesidential ❑ Commercial
If residential, is it: ❑ 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 50 years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backfiow 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#
Electrician Plumber Mechanical H-1004 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: BARGE 5 Print Name: MICHAEL WETZ�ignature ✓u�� 1�Ve��ge� Date