HomeMy WebLinkAbout1316 W Oak St - Applications/Mechanical - 08/22/2017Fcity of Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Services
�— 281 North College Avenue
Fort Collins, CO WW4 Main: 970.416.2740 Fax: 970.224A134
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 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application * 5 0l (4-71Z
For ofPae use only
Date n / 7
Job Site Address (requlmd) Value Construction (labor, materials, Profit)
W.
Property Owper Name Address C /State Zip Phone V6�V
On S
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 Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 4 Report
Saks tarnrmiberls bya#CVn&aCWM Are you paying with your trust account? 4 Yes ❑ No
Is this a residential or commercial project? P Residential ❑ Commercial
If residential, is It: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other ( lain)
Is this building 50 years of age or more? 13YesJFNo If yes; you may need to contact Historic Prheservadon
If this is for a demolition permit, what year was the building constructed?
D iption f ork 1
*If lawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: t tst the company name or Oty of R Collins /knew 0
Electrician 61Q CANO— 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
permtt is not valid until it has been paid and issued.
Applicant: 1�vhn ) Alln
Print Name:JMW ` f l4 Signature 'w Date
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