HomeMy WebLinkAbout504 Maple St - Applications/Air Conditioner - 07/14/2015Jul 141508:32a Swan Heating and Air
970-613-0826 p.2
Fort Collins
OVER -THE -CO
This application is to be used to apply for the follows
❑ Demolition (interior non-structural) ❑ Electrical Alters
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home repl
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood].
manufacturer).
Complete all applicable information on the applicatic
Application #
Far office use only
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
ER PERMITS ONLY
permits only (check all that apply). �ir
i (not service change) ❑ Gas Lighter ❑ Gas Log
merit ❑ Roofing ❑ Sewer Line 0 Photo -voltaic
let Stove (must be EPA certified, provide make, model and
Incomplete applications will not be accepted.
Date ky 7 - / y - 1s�
]ob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone CIZG
Applicant Name Address
CiWState Zip
Phone
Contractor Address
City/State Zip
Phone qZ 0
, %.if in rv4 ro 80'53W
215 , M
Contractor City of F±. Ilins Sales Tax #
e you paying taxes here or by report? Hr* ece' ❑ Report
sales taxnumberisrequredbrallconaartom
a you paying with your trust account?
❑ No
Is this a residential or co ercial project? kl,�sidential ❑ Commercial
If residential, is it: USingle Family Detached ❑ Cond /townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Gara e
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel Motel ❑ Medical office ❑ Office El Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contactHistowProsetvat/on
If this is for a demolition permit, what year was the builds g constructed?
Ifpnorto1975, you wi/fneed anasbestos assessment to swJpmit with thisapp/icabon.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed pluml
Subcontractors: List the company name or G'ty of F7 Collins
Electrician Plumber
I hereby acknowledge that I have read this application and
comply with all requirements contained herein and city ordi
permit is not valid until it has been Paid and issued.
Applicant:
Print Nam
N first-time A/c, must list licensed electrician.
rse 0
Roofer
Other
that the above information is complete and correct I agree to
s and state laws regulating building construction. I know that a
Date --] . )