HomeMy WebLinkAbout2821 Brush Creek Dr - Applications/Air Conditioner - 03/09/2016MAR-09-2016 09:01AM FROM-
9704848354 T-555 P-002/005 F-528
C'rt of�"�
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
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ 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 #� I'C00 Date
Foro/te use only
Job Site Address (&qulned)
Value of Construction (labor, materials, profit)
2821 Brush Creek Dr.
4 850
Property Owner Name Address
City/State Zip
Phone
ChrisKirby 821Brush Cre k
Fort Collin _qCO 80528
970 215-7750
Applicant Name Address
City/State Zip
Phone
Fort Coiling Heatong and Air 2Q8 Commerce
Dr. #4 Fort Coiling, Co 80524
(970) 3,05-3478
Contractor Address
City/State Zip
Phone
Fort Collins Heating and Air 208 Commerce Dr. #4 Fort Collins CO 80524
970 484-4552
Contractor City of Ft, Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
&3Wtax number&rMuimdbya#cvntraclvvs
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? It Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
914ultifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office El Office ❑ Retail
❑ Restaurant El 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?
ffprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*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 ofpt Collins //cense #
Electrician 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 3/9/201 C