HomeMy WebLinkAbout209 Gary Dr - Applications/Air Conditioner - 08/21/2017City of/���planning, Development, & Transportation Services
L+V has Community Development & Neighborhood Services
281 North College Avenue
Fort Collins. CO 8=4 Main: 970AIS.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-sWtituraq ❑Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heading 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 #_ '�) J -t o4q l o Date
Hof ice use only
lob Site Address (re4r&d) Value JCqnWucUon (labor, materials, profit)
Property Owner Name AddressCity/State Zip phone `Q
l� ` 0 - 2
Applicant Name Address aty/Shate Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contradhor Address City/State Zip Phone
Fort Collins Heating &Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484A552
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
sWa rexnunberls bya/lmntractors Are you paying with your trust account? ❑Yes ❑ No
Is this a residential or pommerdal project? t,( Residential 0 Commercial
If residential, is it: IX Single Family Detached ❑ Condo/tDwnhome (single family attached) O Duplex
❑ Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hot"otel D Medical office ❑ Office ❑ Retall
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes JNo if ye; you may need to contact H/storfc heserwMan
If this is for a demolition permit, what year was tHe building constructed?
Description of work
*If lawn sprinlder/Mow preventer, must list licensed plumber. If first-time A/C, must lint licensed electrician.
Subcmrtractore: Litt the company name or Ory of R Cbdlns /kow 0
Plumber Mechardw H1309 Rooter 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 dly ordinances and state laws regulating building construction. I know that a
Permit is not valid until It has been paid and Issued.
Applicant: hill C 1
Print Name: J Signature Date
ReAt w d" MM17