HomeMy WebLinkAbout3615 Rocky Stream Dr - Applications/Air Conditioner - 03/08/2016FES-28-2016 11:38AM FROM-
0704849354 T-468 P-003/004 F-405
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�t C.OUIIIS
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 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
Q Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing O 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. incomplete applications will not be accepted.
Application # Date
Far office use only
Job Site Address (mquired)
Value of Construction (labor, materials, profit)
5 Rockv Strearn Dr.4
14
Property Owner Name Address
City/State Zip
Phone
Keri/Kent Crews 3615 Rocky
Stream Dr. Fort Collins CO 80528
282-1769
Applicant Name Address
City/State Zip
Phone
Fort Colluia$ Heating and Air 209 Commerce
T)r. #4 Fort Calfins, r-O 5
A
Contractor Address
City/State zip
Phone
Fort Collins Heating and Air 209 Commerce Dr. #4 Fart Collins CO 8 24
970 484-4552
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
soles tax number isrequlredbyall mntraemm
Are you paying with your trust account?
CI Yes ❑ No
Is this a residential or commercial project? KResidential ❑ Commercial
If residential, is it: MSingle 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 5o 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? :
Ifpdor to 1975, you wi//need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/bacidlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontracbors: List the company name or City of Collins Ac ense .0
Electridar Plumber
Mechanical H1309 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:
Print Name: Angela Morrow Signature
Date Z12q116