HomeMy WebLinkAbout1436 Salem St - Applications/Air Conditioner - 11/02/2016Feb 02 2000 1028PM One Hour Heating & Air 9706634097
page 2
Fort Collins
Planning,
velopment & Transportation
281 N. Coll
a Ave P.O. Box 580
Fort Collins,
80524
Done 970
16-2740 Fax 224-6134
OVER-THE-COUNTER PER
This application Is to be used to apply for the following permits only (ch
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service chat
M Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing
0 Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must bi
manufacturer).
Complete all applicable Information
o the application. Incomplete appl
Application 011 Date
For of]Fce use only
ITS ONLY
ck all that apply). X! Air Conditioning
le) ❑ Gas Lighter ❑ Gas Log
❑ Sewer Line ❑ Photo -voltaic
EPA certified, provide make, model and
will not be accepted.
Job Site Address (required)
Value of Construction
(labor, materials, profit)
-1436 Salem Street
$20
353.00 = 10
1l (�, S ea(
Property Owner Name Address
Clty/State
Zip
Phone
David Niquette 1436 Salem Street
Fort Collins, CO
80525
970-581-5770
Applicant Name Address
City/State
Zip
Phone
One Hour Heating & Air 487 Denver Avenue
Loveland, CO
80537
970-292-5769
Contractor Address
City/State
Zip
Phone
One Hour Heating & Air 487 Denver Avenue
Loveland, CC
80537
970-292-5769
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes
here or by report?
® Here ❑ Report
Sales tax number isrequlmdbyall contractors,
Are you paying With
our trust account?
M Yes ❑ No
Is this a residential or commercial project? 12 Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Hank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical c
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No lfyes, you mayne
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos asysessment to submit with thls aovlk
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C,
Subcontractors: Ust the company name or city of Ft Collins licenser
Electrician Plumber
Mechanical H-824
I hereby acknowledge that I have read this application and state that the above it
comply with all requirements contained herein and city ordinances and state laws
permit is not valid until it has been paid and issued.
Applicant: Stacey Schmidt
Print Name: Signature
attached) ❑ Duplex
❑ Office ❑ Retail
contact Historic Preservation
list licensed electrician.
Other
is complete and correct. I agree to
building construction. I know that a
Date 111/094'_�OW