HomeMy WebLinkAbout1308 Lory St - Applications/Furnace - 10/24/201717R553
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
This application is to be used to apply for the following permits only (check all that apply). QxAir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
0 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). 11A.11
Complete all applicable information on the application. Incomplete applications will not be accepted.
ll°1•I�
Application �Q?\]6Ib5 Date 10194117
For office use on7
Job Site Address (required)
Value of Construction (labor, materials, profit)
1308 Lory St, Fort Collins 80524
A3611b0
Property Owner Name Address
City/State Zip
Phone
Jim Hayes 1308 Lory St,
Fort Collins, CO 80524 303-710-1849
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
IMS Heating and Air 5213 Longs Peak
Rd, Unit A Berthoud, GO 80513
970-532-0123
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? q 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 (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of •rk Install 13 seer 2 ton 80,000 htu • Pffirjent furnnrp
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Co of Ft Collins license #
Electrician Plumber
Mechanical 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: ! �,
Print Name: �G +1'\ t F t +' l-� �1 1 Signature— fC\Ylti�-` �L L Date
I%