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HomeMy WebLinkAbout2044 Churchill Ct - Applications/Furnace - 08/26/2016Aug 26 16 12:01 p Swan Heating and Air 970-613-0826 p.2 aw. of Flirt Cf--:)I11e-T -v,':s OVER-TH This a plilaWan is to be used to apply ❑ go1holition (interior non-structural) 13 E eating Unit 13 Lawn Sprinkler ❑ Mo ❑ Ventilation Q Water HeaW ❑ Water i manufacturer). Complete all applicable information on Application # 6 1 U �) 5 ►rar a7te use only Planning, Development & Transpofttion 281 N. Coliege Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416 2740 ! Fax 22"n4 .OUN R PERMITS ONLY the foll permits only (check all that apply).12 Air Conditioning bical Al n (not service change) 0 Gas Lighter ❑ Gas Log Home rep ement ❑ Roofing 0 Se dr Une © Photo-voUaic 13 Wo eilet Stove (must be EPA certified, provide make, model and a applicaiio I. [acamplete applications "I not be accepted. Date —<;4 60 ` t C; Job Site Address fra7ulradtl Value of; Consbucd6n (labor, nUterials, PM) Property Owner Name A Jdress City/state Zip Prone G-70 Cliurnki 6. F : 6 liti S. 13 - Ap lit Na dress City/Stat�e 'Zip Phorte Contxacbm A fdress GLy/Stat+e Zip Phone Q-7 C) c 15 - '�! Conbactor City dHk. Collins Sales Tax m you paying taxes here or bar report? alfe e a Report Sales tax nzwAsr.10mv�dbyaY=ahadmm you paying with your trust account? lres O No Is this a residential or�ooerdal projecC? Gtesidentiai Q Commercial If residential, is it E7 Single Family beta ed 13 Co tnwnhame (single fam�y attached) Duplex ❑ Multifamily (a�rtm ) 11 Garag i� If mmmerdal, [s itt 1J Bank ❑ Bar 13 C3 Robed .ot�el C1 Medical office Cloffice CI Retail 13 Restattrdrtt Cl (eviain Is ibis b ilding SO years of age or mflne7 Yes a yes, yeu mal',�ead to azr�factH�stasic Preserval9on If this is for a demolition Perm* what was the builds constructed? rfprferto 1975, you W71 need an asbasius enthD s 't Kim m& Agacation. Desalptlon of work **lawn sprinkleribecI law prevenber, mmt t Subcontractors List dwcompany narrre or Eled3idan I hereby acknowledge that I have read this ap comply with all requirementsaontalned herein permit is not valid until it has been paid o Applicant., Print Name sensed plumbe�flrst time A/C, must list Ycensed electrician. of 001M tion and s1atopat the above information Is complete and correct: I agree to my ord I and staff laves regulating building canstuc ion. I kww that a issued. Date Il ^Q Lo -- [ L