HomeMy WebLinkAbout1043 Mullein Dr - Applications/Air Conditioner - 12/08/2016'/6/2 DEC-O6-ZUR9)r:OIAIlSTFROW TO:19702246134 FROM:719sT�49aB35d4 T-861r'F& 1F-218
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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit O 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 information on the application. Incomplete apiiplicationns willnotbe accepted,
Application #_ � 1 �� Date I o i L)' QC_Ji✓ l�
For offlm use only
Job Site Address (required)
104
Value of Construction (labor, materials, profit)
Mul I ein Or.
Iwo, Z5I
Property
ner Name Address
City/State Zip
Phone
LUiS
P,rli u2 Oy3
Or r Col i S
7
Applicai
Name 1 Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Fort C llinc Heating and Air 208 Commerce Dr. #4 Fort Collins CO 80524
970 484-4552
Contractor City of Ft Collins Sales Tax #
i
9a/estMYnaa9W1:5nequkedbya#cvnbactars.
Are you paying taxes here or by report?
❑ Here ❑ Report
Are you paying with your trust account?
❑ Yes ❑ No
Is this i
If resich
If comn
Is this t
If this is
ifp for
Descril
*If lawr
residential or commercial project? 'dff Residential ❑ Commercial
itial, is it: Iftingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
ercial, Is it: ❑ Bank Q Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
jilding 50 years of age or more? D Yes ❑ No If yes, you may need to contact Historic Preservat/on
for a demolition permit, what year was the building constructed?
v 1975, you will need an asbestos assessment to submit with this application.
of work
sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
L& Lire Company name or Gty of Collins lkense #
Plumber Mechanical H1309 Roofer
Other
I herebyadofowledge 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.
Signature
Date It 12S/16