HomeMy WebLinkAbout531 E Stuart St - Applications/Air Conditioner - 04/26/201711201 W-Z0-Y017011JBM AMFR RT
TO: 19702246134 FROM97d4jaAV07234 T-199 P URN?: F-5566
of
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.0 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). ❑ Air 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 ❑ 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 # 5 130-22 6 J Date
for affix use only '
lob Site Address (requaed)
Value of Construction (labor, materials, profit) 66, 2
Lazu tt
hA St
Fort C °
q
Property Owner Name
Address
City/State Zip
Phone
4
ak
s
1692.
Applicant Name
Fort Collin-, Heating and Air 208
Address
Commerce
City/State Zip
Dr. #4 Fort Collins CO 96S94
Phone
(270) 1Q5.147R
Contractor
Address
City/State Zip
Phone
Fort Collms Heatme and Au 208 Commerce Dr. #4 Fort Collms CO 80524
970 484-4552
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
sakes taxnwnw ra regmwbya#amtrac1=
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial prolect7 OdResidg4tial ❑ Commercial
If residential, is it: ❑ Single Family Detached Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is ito ❑ Bank ❑ Bar ❑ Church [3 Hotel/Motel ❑ Medical office ❑ Office 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, yvu may need to contact H/stunc Presermbon
If this is for a demolition permit, what year was the building constructed?
If pttor to 1975, you wi11 need an asbestos assessment to submit with this appltrabon
Descripton of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L&Mecompany name orCltyofFtCollmslicense0
Eleoidan Plumber Mechanical H1309 Roofer
Other
I hereby adawwWp 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 budding construction I know that a
pemhit Is not valid until it has been paid and issued.
t Nkit: Print
��U�/ 9/20M
Print Name- Angela Morrow signature Date
I]