HomeMy WebLinkAbout3700 Coronado Ave - Applications/Air Conditioner - 08/21/2017~Fcity of,� Planning, Development, & Transportation Services
ort Cott s 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).4 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 # 61 qt�4 -02--,
For office use only
Date �/02 l �� AUG i w-
Sob Site Address (requlnad) Value of Collstruc11�ti^^onn (labor, materials, profit)
J11
roperty Owner Name Address CityState z1 Phone (44
Applicant Name Address City/State tip 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 V Report
Sales raxnumbwIsrequNedbyaamn6achxs Are you paying with your trust account? Yes ❑ No
Is this a residential or commercial project? bf Residential ❑ Commercial
If residential, is it: Single Family Detached 13 Condo/townhome (single family attached) ❑ Duplex
MuMrrdly (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church O Hotel/Motel 0 Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes i 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
-Ump IRE
*If lawn sprinkler/bacidlow preventer, must list licensed plumber. If first-time A/C, must list licensed elecbidan.
Subcontractors: Ustthe mmpanyname orOtyofRCoffins lkhmse#
Eledridan Plumbs 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: ,ate
Print Name: Signaturepgnem
Date v
RevWon ame 2UM7