HomeMy WebLinkAbout216 Pitner Dr - Applications/Air Conditioner - 07/08/2015Planning, Development & Transportation
city
of ° 281 N. College Ave P.O. Box 580
Fol t CO11ins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER -THE -CO NTER 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
ZI 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.
B I S v sao I
Application # Q I SO 5aoo
For office use only
Incomplete applications will not be accepted.
Date
7/8/15
Job Site Address (required)
Value of Construction (labor, materials, profit)
216 PITNER DR
5000.00
Property Owner Name Address
City/State Zip
Phone
DENNIS GUENTHER 216 PITNER DR
FT. COLLINS
970-988-9896
Applicant Name Address
City/State Zip
Phone
IMS HEATING & AIR 5213 LONGS PEAK RD UNIT A BERTHOUD
970-532-0123
Contractor Address
City/State Zip
Phone
IMS
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
In Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes 1Z No
Is this a residential or commercial project? L1 Residential ❑ Commercial
If residential, is it: II 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 If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
REPLACE 70K BTU FURNACE AND 2 TON 13 SEER AC
*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#
Electridan 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: 7/8/15
Print Name: GENNA DAY Signature GENNA DAY Date