HomeMy WebLinkAbout636 Cheyenne Dr - Applications/Air Conditioner - 06/21/20173/13/21V 3-ZQl7j':d1PMPMFMT TO: 19702246134 FROI%ir 4jaAV07234 T-5Z9 P 9111/lhQS : F-9951
MAIL PERMIT TO HOME OWNER ... MAIL RECEIPT TO FCHA
Cl t of planning, Development, & Trensportadon Services
C011Ins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970 416 2740 Fax 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
O Demolition (Interior non-structural) O Electrical Alteration (not service change) 0 Gas Lighter 0 Gas Log
13 Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement O Roofing O Sewer Line 0 Photo -voltaic
0 Ventilation O Water Heater O Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete ap/plicatiioon's will not be accepted.
Application #_ ("�y J + Date IWICJi JQ
form use &*
Sob SM Address (faw*ed) Value of Construction (labor, materials, profit)
4
Property Owner Name Address City/State Zip Phone
6Earl 5
Ap'Nnt Name Address Qty/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. 04 Fort Collins, CO 80524 970.484.4552
Conbactor Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. 04 Fort Collins, CO 80524 970.484.4552
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 0 Report
&9wnwnw►naeris,eormedaya9ov&acvrs Are you paying with your tort account? O Yes 0 No
Is this a residential or commercial project? OtResideDtial 0 Commeroal
If residential, is it: 0 Single Family Detached Condo/townhome (single family attached) O Duplex
0 Multifamily (apartment) ❑ Garage
If mmmetcial, is it: 0 Bank O Bar ❑ Church 0 Hotel/Motel 0 Medical office ❑ Office O Retail
O Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 0 Yes O No If M you may need to contact H,%srw/c Pm mmation
If this Is far a demolition permit, what year was the building constructed?
Description of work
nwlnea- Ac
'elf lawn sprmider/bacidtow prewder, must list licensed plumber. III fiust`tlime A/C, must list licensed electrician.
Subowrtracboms: L&Ifie conWnyname orQry ofRCoNm item 0
Electridar plumber Mechanical H1309 hoofer Other
I hereby acknowledge that I have read this application and state that the above inforrnabon is complete and correct. I agree to
comply with all requirements contained herein and dry ordinances and state laws regulating building construction. I know that a
permit is not %Wid until it has been paid and issued.
Appli
print r4a Jennifer Sepulveda
PrimmttName• slgt>atua Dais (0/11/1'1
A,— dMIE eon
.-Woq