HomeMy WebLinkAbout209 S Loomis Ave - Applications/Furnace - 08/11/2017,FCity of P1ann/ng, Development, & Transportation Services
ort 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
*I Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pallet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applic ons III no a accepted
Application #22viN1-J Date I I
roraft a usie only
lob Site Address pequ/red/ Value of t �� (labor, materials, profit)
Pro rty Owner Name Address city/State Zip Phone
M
Applicant Name Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr #4 Fort Collins, CO 80524 970.484.4652
Contractor Address City/State Zip Phone
Fort Collins Healing & Air 208 Commerce Dr 04 Fort Collins, CO 80524 970 484 4552
Contractor City of ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 0 Report
Sa/eWnurnbarIsmqubedbya#mntractws Are you paying with your trust account? jgYes ❑No
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: Single Faintly Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) 13 Garage
If commercial, Is it- ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retall
❑ Restaurant ❑ Other ( lain)
Is this building 50 years of age or more? C1YesjQNo Ifyes, you may need to contact HLs akFrieswimaon
If this is for a demolition permit, what year was the building constructecP
Description of work
*If lawn sprinider/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontradome uat the company name or Oty of Fit Coen ►kiense #
Ek*rldan Plumbe► 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 nt Name- Imxt1_ _ 11`1ML Signature
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