HomeMy WebLinkAbout6409 Garrison Ct - Applications/Air Conditioner - 06/15/2015Ciof
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 1 7o L �2
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 19'Air Conditioning
molition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating 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 # 15V-Sc S 2� 5 Date ���✓ ! �S
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Owner Name
Address
City/State Zip
Phone
Aoperty
ylndom AM
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COy
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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? Ire
❑ Report
Sales tax number isrequired byall contractors.
Are you paying with your trust account? ❑ Yes
❑ No
31254
Is this a residential or commercial project? Iff Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Cando/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/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 #
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: MICHAEL WETZBARGER /
Print Name: ignature ✓��Gt"'fi yYe-tzba�gey' Date(010 6