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HomeMy WebLinkAbout1511 Lakeside Ave - Applications/Air Conditioner - 07/19/201607/19/2016 11:19 FAX 970 686 6087 AMERI CAN AIR BEATING INC i CITY OF FT COLLN 10001 'bra pe. FCir of ���� / Planning, Development & Transportation Collins � Z$! N. College Ave P.Q. Box 580 Fort Collins, CO 80524 . r�it k { 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). 1114ir 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 C3 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 # k311Poqi9 'Date For ofte use only . Job Site Address (required) Value of Construction (labor, materials, profit) )5 /> 2 wke ; $ 325c->`�' Property Owner Name b(-%*4,e 1 7z> rnow Address l5)1 City/State ke. k s;JR_AVe. zip $40A i Phone 7ZQ -9 78 - 874 Applicant Name Address . City/state Zip Phone Contractor Lic # Address City//State a zip Phone Jl en!'aK /�rY >��� -� %�i 5(p ( l� �krdeh �r• �� f�/�ndsar. e0- go3�v 971) (oyla-490F40 Contractor City of Ft. Collins Sales Tax # 93y� � Are you paying taxes here or by report? a Here ❑ Report Sales tax numberis required byall contractors Are you paying with your trust account? des ❑ No Is this a residential or commercial project? Q"Residential Q Commercial If residential, is it: f�ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) © Garage If commercial, is it ❑ Sank C] gar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ other (explain Is this building 50 years of age or more? ❑ Yes GYNo Af yes, you may need to -contact Histoge Prewivadon If this is for a demolition permit, what year was the building constructed? ifpr1ar to 1975, you wlll need an asbesiw assasirrent to submit with this appl/cadon. Description of work Ajj *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors, Ust the company name or City of Ft Collins license # Eiectriclan fY r riRa if 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. Appricant: Vic. Print Name: "�'1 �f Signature �191 fate 7- f 9,- /6