HomeMy WebLinkAbout3339 W Prospect Rd - Applications/Air Conditioner - 07/25/2017PLEASE MAIL PERMIT TO HOMEOWNER
City of Planning, Development, & Transportation Services
Fort Collins 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). K2AirConditioning
❑ 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 # r704064 Date I . -2-D • 1-7
For ofte use only
Job Site Address (required) Value of Construction (labor, materials, profit)
3339 W Prospect Rd $4,721.10
Property Owner Name Address City/State Zip Phone
Larry Graham 3339 W Prospect Rd Fort Collins, CO 80526 202.438,9071
Applicant Name Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr., Unit 4 Fort Collins, CO 80524 970.484.4552
Contractor Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr., Unit 4 Fort Collins, CO 80524 970.484.4552
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here M Report
Sales tax number IsrequI edbyal/ronbwtors. Are you paying with your trust account? M Yes ❑ No
Is this a residential or commercial project? ;Residential ❑ Commercial
If residential, is it: KSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
IJ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office Cl Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? Q Yes JKNo If yes, you may need to contact Historlc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work _Replace air condefloner
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license dr
Electridan Plumber Mechanical H1309 Roofer Other
I hereby acknowledge 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 building construction. I know that a
permit Is not valid until it has been paid and Issued.
Applicant:
Print Name: Julie Prall Signature Date
Revislon We 202017