HomeMy WebLinkAbout2005 Stover St - Applications/Air Conditioner - 05/02/201616R162
Fort Collins
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). � 8$
Complete all applicable information on the application. Incomplete applications will not be accepted. IT
Application # 6 IQ o A?) Date 05/02/16
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
2005 Stover St
$5550.00
Property Owner Name
Address City/State Zip
Phone
Mike Haves
2005 Stover St Ft Collins CO 80525
303-909-288
Applicant Name
Address City/State Zip
Phone
IMS Heating and Air
5213 Longs Peak Rd, Unit A Berthoud CO 80513
970-532-0123
Contractor
Address City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? 5a Residential ❑ Commercial
If residential, is it: k7 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 Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Replace 3 ton Air Conditioner
*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 Plumber Mechanical IMS Heating 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: Rita Ulbrich Signature Date 05/02/16