HomeMy WebLinkAbout1013 W Mountain Ave - Permits/Air Conditioner - 07/13/2017'/5/20b 05-ZUR2 bJ:07Pt1M TO: 19702246134 FROM :97 464E35d7234 T-766 P.V1147014 F-461
MAIL PERMIT TO HOME OWNER...MAIL RECEIPT TO FCHA
City of Planning, Development, 1& Transportation Services
-+��r1s 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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing d 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 # b I,,-] 0�5 , Date
For ofte use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
o
Property Owner Name Address City/State Zip Phone
RgAllyman e efaA Calhaz
.
Applicant Name Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Safer tax mmntertsrequlmdbyall contractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or coal project? iQdential ❑ Commercial
If residential, is it: ErSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church I] Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 0 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work rQoloea. AC
*If lawn sprinlder/backflow preventer, must fist licensed plumber. If first-time A/C, must list licensed electrician.
Subcontraetors: List the company name or City of Ft Collins %cense #
Electrician Dh CA I I Plumber Mechanical H 1309 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.
Applicane.
Print Name: Jennifer Sepulveda Signature Date 115111
Rwi;im Oats ZWO17