HomeMy WebLinkAbout1656 Ukiah Ln - Applications/Furnace - 01/28/2016Jan 2816 07:25a Swan Heating and Air
970-613-0826 p.1
Fort Collins
OVER-TH
This application is to be used to apply for the folio+
XDlition (interior non-structuraq ❑ Electrical Alte
ting Unit J' Lawn Sprinkler 0 Mobile Home re
❑ Ventilation l3 Water Heater ❑ Water Line ❑ Woo
manufacturer).
Complete all applicable Information on the applicat
IQ 604ifi
Application # � 1(p604(-6 a
Faros use an/y
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416 2740 Fax 224-6134
PERMITS ONLY
permits only (check all that apply). ❑ Air Conditioning
i (not service change) ❑ Gas Lighter ❑ Gas Log
ment ❑ Roofing 0 Sewer Line ❑ Photo -voltaic
let Stove (must be EPA certified, provide make. model and
Incomplete applications will not be accepted.
Date �LLLh
Job Site Address (requlred) !
Value of Construction gabw, materials, pront)
0339,52=�
Property Owner Name Address
City/state Zip
Phone
Q
Applicant Name Address
City/State Zip
Phone
Contractor Address
Gty/State Zip
Phone
g
8'05
2f S
Contractor City of Ft 611ins Sales Tax #
Are you paying taxes here or by report? ��ye
❑ Report
Sa/estaxnumberkrenuiredbyail caaftacims.
re you paying with your trust account? i�'Yes
❑ No
Is this a residential or com�rmmercial project? 13 Residential ❑ Commercial
If residential, is it: Iff Single Family Detached ❑ Cord /townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Gara
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hote! Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant. ❑ Other (explain
Is this building 50 years of age or more? ❑ Yes No' Ifyes, you may need fo contdctHL=icPreservation
If this is for a demolition permit what year was the buddl ig constructed?
Ifpriorto 1975, you wi//need an asbestos assessment to it witfi /figs applimhon.
Description of work
*If lawn sprinkler/badcflow preventer, must list licensed plum ' . If first-time A/c, must list licensed electrician.
Subcontractors: LI&Me cvmpany name orOtyofFtCoMrs ,erase rk
Electrician Plumber Mech "cal Roofer Oilier
I hereby acknowledge that I have mead this application and
comply with all requirements contained herein and city ordl
permit is not valid until it has been paid and issued.
Applicant:
Print Nami
that the above information is complete and correct I agree to
and state laws regulating building construction. 111 now that a
0