HomeMy WebLinkAbout909 Chippewa Ct - Applications/Air Conditioner - 08/29/2016From 9702299983 1.970.229.9983 Mon Aug 29 15:39:20 2016 MDT Page 2 of 5
FROM : FAX NO. :
Aug. 29 2015 09:37PM P2i5
Fart Calkins
.
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). VAir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing EI Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be SPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # F) � (.00 bO '�5 Date
For of'lee usw only
Job Site Address (required) Value of Construction (labor, materials, profit)
_909 CH. PPFWA CT $4350.00
Property Owner Name Address City/State Zip .. Phone
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
NORTHERN COLORADO AIR, INC. 81.2 STOCKTON AVE FT COLLINS CO 80524 970-223-8873
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Xf Here ❑ Report
Sales tax nomberisWi ited by all contractois. Are you paying with your trust account? JdYes ❑ No
26862
Is this a residential or r mmercial project? VResidential M Commercial
If residential, is it: PSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) G3 Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 13 Medical office 13 Office ❑ Retail
0 Restaurant ❑ Other (expl in) ._ __
Is this building 50 years of age or more? 0 Yes No Ifyes, you mayneed to contactHisharic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos a ssawment to submit with this application.
Description of work
ur<.R1 ACL AC
*If lawn sprinkler/backfiow preventer, must list licensed plumber. Tf first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Elecuidan 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. '
��^ `` 1
Applicant: T `C��� 1� `l/Cl /a•l.i�
Print Name: jU l-4 Y,t /iL Signatu _y1P__ ' IL
t.� Date-21 �1