HomeMy WebLinkAbout4518 Goshawk Dr - Applications/Air Conditioner - 11/13/2015Nov 12 2015 05:12PM . One Hour Heating & Air 9706634097
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Fort Collons
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 ON
This application is to be used to apply for the following permits only (check all that app(YLo Air Oonditio ,a--'
interior non-structural) El Electrical Alteration (not service change) El Gas Lighter s og
Heatin ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photovoltaic
Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). : G
Complete all applicable information on the application. Incomplete applications will not be accepted. / ff n I
Application # i" I �U i Date 13
For ofte use only
Job Site Address (requlmd)
Value of Construction (labor, materials, profit)
4518 Goshawk Drive
Property'Owner Name Address
City/State
Zip Phone
Mark Jones 4518 Goshawk Drive Fort Collins, CO
80526 910-581-2543
Applicant Name Address
City/State
Zip I Phone
One Hour Heating & Air 487 Denver Avenue
Loveland, CO
80537 970-663-4002
Contractor Address
City/State
ZIP Phone
One Hour Heating & Air 487 Denver Avenue
Loveland, CO
80537 970-663-4002
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? E Here ❑ Report
Sales tax number Is required by all contractors
Are you paying with your trust account? E Yes ❑ No
Is this a residential or commercial project? RI Residential ❑ Commercial
If residential, Is It: Ea 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 may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you w111 need an asbestos assessment to submit with this application.
Description of work Replace fie, AC and evaporative coil
*If lawn sprinlder/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List bye company name or City of Ft` Collins license #
Electrician Plumber Mechanical H-824 Roofer Other
I hereby acJmowledge 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: Stacey Schmidt
Print Name: Signature
s4" sd
Date I I. I II iS