HomeMy WebLinkAbout4674 Snow Mesa Dr - Applications/Air Conditioner - 09/07/2016From 9702299983 1.970.229.9983 Tue Sep 6 09:12:16 2016 MDT Page 1 of 1
FROM FAX NO. Sep. 06 2015 03:10PM P1/1
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city oft
[��"` Collinslanning, De eloprrren# rra
281 N. College Ave P.O nSPortation
Fort Collins, co 80524 Box 580
Phone 970-416-2740 Fax 22,4 134
This 8 �v-r,-�au�rr
application is to be used to a ER f
Cl Demolition Unit
norSprinkle Apiy for the foilowin ONLY
Heating Unit ) ❑ Electrical 11OW n Permits onlyIEF
(check all that appiytl rIA!r ConditioninCi
� VenH(ation O Mobile Ho p (not service change) p Gas Light�`-'
Water Heater me replacement ❑ Roorin r
Manufacturer). Water Line ❑ Wood/Pellet Stove $ ❑Sewer tine 173 Gas L og
Complete all applicable information an the a (must be EPA Certified, prQyi�eoto-voltaic
Apltcation. taco i make, modal and
Application # n ((D 0
&roffice use on/y
]ob Site Address (ro uu
Property Owner Name
Applicant Name
Contractor
NORTHERN COLORADO AIR, INC.
Contractor City of Ft. Collins Sales Tax #
Sales tdx4uinberlsi
regr rr�dby all cor tr'acrors
26862
mn ete applications will not be accepted.
Date
Value 4f Construction Qabor,
materials, profit)
Clay/State
ZIP Phone
Address 5
city/State z,-fi
Phone
Address City/State
812 STOCKTON AVE FT COLLINS zip Phone
Cb Sp5z4
970-228-8873
Are you paying taxes here or by report? gi Here
Are you paying with your trust account' ❑ Report
. Yes 1:3 No
Address
Is this a residential or commercial project? ❑ Residential
If residential, is it: [I Family Detached ❑Condo/t CO mee (single
If commercial, is it: ❑ Bank El Bar Q Church Q El Garage
HoteVMotef ( 9 family attached) CI Duplex
11 Restaurant 0 Other (expl 'n) yMedical office ❑ oice ❑ Retail
I5 thiS Wilding 50 years of age or more? ❑Yes No rf yes, you may need to contact Historic vreservat/vn
If this iS for a demolition permit, what year was Ite building constructed? _. _..
If prior to i975, you will need an asbestos assessment to submit with this application.
Description of work—
c+m • r * w rr�Tr am r +
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time NC, must list licensed electrician.
Subcontractors: Ust the company name or City of Ft Collins license g
Electrician NIQ L. Plumber - ._ Mechanical_, Roofer other.,
I hereby acknowledge that I have read this applln6on 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. x know that a
permit Is not valid until it has been paid and Issued.
f
Applicant: �
Print Signatu�1[...... `•... "U`� Date