HomeMy WebLinkAbout7502 Gold Hill Ct - Applications/Air Conditioner - 07/13/201607/13/2016 07:31 FAX 970 686 6087
4
AMERICAN AIR HEATING INC 3 CITY OF FT COLLN IM 001
of
Flirt Collins
OVER.-
Planning, Development & Transportation
� - 281 N. College Ave P.O. Box 580
-�. Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
E-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 111"Air Conditioning
0 I)emoiition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Q Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line 1:3 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 # 1?5I to 0 314
Fvr olr1ce use only
Sob Site Address (required)
75 o2- a o lJ g; %/ �7l-
Date
7-/3--//
Value of Construction (labor, materials, profit)
$ '712 5 -
Property Owner Name
Address City/State
Zip
Phone
pbe�+ Ate*-irJ
'7662- Co U 001 c-, FC .
805�i`5
989 - 22 7
Applicant Name
Address City/State
Zip
Phone
Contractor Lic # Address City/State Zip Phone
�rrrrr��arr�fr`r /F #-17V .5fk f 6 1�ardek7&--*F kl ndsOr-; GAD• 90 'aO 17069&-10?(P
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? mere ❑ Report
Sales tax number is required by all conbwdars "� 4' Are you paying with your trust account? des ❑ No
Is this a residential or commercial project? WResidential ❑ Commercial
If residential, is it: it Single Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ gar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑Office ❑ Retail
❑ Restaurant ❑ Other (explain)
is this building 50 years of age or more? O Yes MrNo Y)e* you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you w/lI deed an asbeft assessment to submit with tf5is application.
Description of work A -A
On; -):s ( I A/L, titN 11—
*If lawn sprinkler/backfiow preventer, must fist licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft COMM lice 7s a ,#
Electridan kl r d Plumber Mechanicai 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: �t
Print Name: '� r �I Signature - Date