HomeMy WebLinkAbout609 Brewer Dr - Applications/Air Conditioner - 02/22/2018.FC-II Planning, Developmenl� & Transportatlon Services
o dins Community Development & Neighborhood Services
281 Nonh College Avenue
Fort Calling, Co 80524 Main: 970.418 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). O Air Conditioning
O Demolition (Interior non-structural) O Electrical Afteration (not service change) O Gas Lighter O Gas Log
O Heating Und 0 Lawn Sprinkler O Mobile Home replacement 17 Roofing O Saw Line O Photo -voltaic
O Ventilation ❑ Water Heater O 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 cbe accepted
Application #b
_ t> U ) i U Date
ForaYce uar a*
Job Sibs Address (7egUI Value of Construction (labor, materials, profit)
Property Owner Name Address city/State Zip Phone
AL long By'wu f F aS 10 y I
Applicant me Address aty/State ?1p 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 FL Collins Sales Tax # Are you paying taxes here or by report? O Here ■ Report
Saks tax nuebw& mp bed by all awlygaars, r2, Are you paying with your trust account? ■ yes O No
Is this a residential or commercial project? ❑ Residential 17 Commercial
If residential, is it: 13 Single Family Detached 0 Condo/townhome (single family attadied) 0 Duplex
❑ Multifamily (apartment) 13 Garage
If commercial, Is it: ❑ Bank O Bar O Church 13 Hotel/Motel 17 Medical ofibe O office O Retail
❑ Restaurant 0 Other (explain)
is this building so years of age or more? 13yes ClNo If yes,, you may need ib aoritad Histor/c Pfaier- aura
If this is for a demolition permit;, what year was the building constructed?
Description of work
*If lawn sprinkler/backnow preventer, must list licensed plumber. It first-time AJC, must list licensed electrician.
Subemmtractora; List the uvnApany name or aly of Collins /in m #
Eleriridan Plumbef mechanical H1309
Roots 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 budding construction. I know that a
Permit is not valid until It has been paid and Issued.
Applicant: C An
Print NameSignature DOW
Rayfpar, dale?RR017