HomeMy WebLinkAbout812 Smith St - Applications/Air Conditioner - 08/15/2017�City of Planning, Development, & Transportation Services
�t Co«inS Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 60524 Mein: 970A 18.2740 Fax 970.224.0134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). iAir Conditioning
O Demolition (interior non-structural) 0 Electrical Alteration (rat service change) 0 Gas Lighter � C] Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Une 0 Photo -voltaic
❑ Ventilation i] Water Heater 0 Water Line E3 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 # t) 1 �o� OI Date AUG 15 2017
For o8ke use only
Job Sibs Address (required) Value of Construction (labor, materials, MR)
tom\ �'J�►(
PropertyOwnero me dress City/Sta Zip one CAF
To..
Applicant ame Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970 484.4552
Contractor Address city/State Bp Phone
Fort Collins Heating & Air 208 Commerce Dr #4 Fort Collins, CO 80524 970.454.4552
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here (Report
saws tarnwnber bya#CW& ftAM Are you paying with your trust account? Jf Yes No
Is this a residential or mmerdal project? Residential 0 Commercial
If residential, Is it: J49ngle Famiy Deta CI Condo/townhome (single family attached) ❑ Duplex
O Multifamily (apartment) ❑ Garage
If commercial, is It: O Bank ❑ Bar 13 Church 13 Hotel/Motel 0 Medical office 0 Office ❑ Retail
CI Restaurant 0 Other (again)
Is this building SO years of age or more? 13Yes IX No IfYery you mayneed to mnfact H&W=Preser hbo
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinklertbaddbw preventer, must Ust licensed plumber. If first-time AiC, must list licensed electrician.
Subcontractors: List lire company name or Uty of Ft Ofts fitwse 0
ElecbIdaZ _ Plumber Med nicai H1309 Poorer 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: � C
Print Name: Signature Date
asYwm dit 20=17