HomeMy WebLinkAbout1223 Juniper Ct - Applications/Water Heater - 02/09/201602/09/2016 09:05 FAX 970 686 6087 AMERICAN AIR HEATING INC 4 CITY OF FT COLLN Z 001
Planning, Development & Transportation
�itY+Qf Alf' 281 N. College Ave P.O. Sox 580
F6r t Collins o �. Fort Collins, CO 80524
P r Y ( Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER 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 tighter Q Gas Log
ElrHeating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line Q Photo -voltaic
❑ Ventilation C Water Heater ❑ Water Line El Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)_
Complete all applicable information an the application. Incomplete applications will not be accepted.
Application #J3 1 (e Q (:) U,'Lt_- Date - - 2 - 9 - /ZQ
ror ornco use omy. w 5
Sob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name
ve- i.« RQ LLe44,_o
Address City/State
122. iCC
zip
D5.7
Phone
`/70-S/ -1038,
Applicant: Name
Address City/State
Zip
Phone
Contractor Lic # Address City/State zip Phone >
r �'kr {a Y.'�� l�, Sir C1e970 64-&~&ORP
Contractor City of Ft_ Collins Sales Tax # �J& Are you paying taxes here or by report? Here part
Sales tar number rsmVuiredbyaliconbactD,r. '` Are you paying with your trust account? des ❑ No �
Is this a residential or co mercial project? WResidential ❑ Commercial
If residential, is it: 153 Single Family Detached 13 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 62"No If ye!, you may need to contact HlMvrk Preservation
If this is for a demolition permit, what year was the building constructed?
0p17or to 1975, you will need an asbestos assessment to submit with this application.
Description of work Ra,4214c,_ P'KCrar_— 7?4-1214e,_ 7a nkl&-s5
*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 k1 leo( e e,, Plumber Mechanical __ _- 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: �/r
Print Name: o'er�ay ��""`� / Signature _` r Date