HomeMy WebLinkAbout1924 W Lake St - Applications/Air Conditioner - 05/19/2015City of
F®rt Collin -1
OVER-THE-COUN ER
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). I"] Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
In 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.
� ISosaT-q
Application # 3)SQGDf�
For office use only
Incomplete applications will not be accepted.
Date 5/19/15
Sob Site Address (required)
Value of Construction (labor, materials, profit)
1924 W LAKE STREET
5000.00
Property Owner Name Address
City/State Zip
Phone
WILL HYDE 1924 W LAKE ST
FT. COLLINS
303-898-4098
Applicant Name Address
City/State Zip
Phone
IMS HEATING & AIR 5213 LONGS PEAK RD UNIT A
BERTHOUD 80513
970-532-0123
Contractor Address
City/State Zip
Phone
IMS HEATING &AIR
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? tl Here
❑ Report
sales tax number is required by allmntractorm
Are you paying with your trust account? ❑ Yes
1!9 No
Is this a residential or commercial project? b Residential ❑ Commercial
If residential, is it: n 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 ❑ No Ifyes, you mayneed 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 INSTALL 2 TON AC AND 70K BTU FURNACE
*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 IMs 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:
Print Name: GENNA DAY Signature GENNA DAY Date 5119115