HomeMy WebLinkAbout405 Mathews St - Applications/Mechanical - 12/11/2018City of Planning, Development, & Transportation Services
Fort 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
X 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).
Complete all applicable iinforma(ti1on on the application. Incomplete applications will not be accepted.
Application # 1 J 1sl y1 HC-3 Date DEC 1 1 2010
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
405 B Mathews Ave, Fort Collins, CO 80524 $3,000.00
Property Owner Name Address Citv/State Zip Phone
Young Peoples Learning Center 405 B Mathews Ave Fort Collins, CO 80524 970-691-0487
Applicant Name Address City/State Zip Phone
Young Peoples Learning Center 405 B Mathews Ave Fort Collins, CO 80524 970-691-0487
Contractor Address City/State Zip Phone
Air Comfort, Inc. 150 Rome Court Fort Collins, CO 80524 970-490-1458
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? El Here ❑ Report
Sales tax number is required by all contractors. - Are you paying with your trust account? [K Yes ❑ No
31791
Is this a residential or commercial project? ❑ Residential X 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 X Other (explain) —Child Care
Is this building 50 years of age or more? ❑ Yes X No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Replace Boiler with 66 BTU Boiler - Connecting to existing water, electrical, -
and flue piping.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical H-1321/1641-H 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: Breanna Grimes / G___��Date12-10-18
Print Name: Signatur 'zi`�
Revislon date 2/6/2017