HomeMy WebLinkAbout1945 Promenade Way - Applications/Air Conditioner - 03/14/201717R65
Planning, Development & Transportation
Fori= Fort N. College Ave P.O. Box 580
1 Collins1 1 Collins, CO 80524
Phone 970-416-2740 Fax 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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Meating 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 information on the application. Incomplete applications will not be accepted.
Application
6 1 f701,314
For ofce use only
Date rki J-14 1-7
Job Site Address (required)
Value of Construction (labor, materials, profit)
1945 Promenade Way Fort Collins 80526
3050.00
Property Owner Name Address
City/State Zip
Phone
Sam Cole 1945 Promenade Wy Fort Collins, CO 80526
404-791-1077
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
IMS Heating and Air 5213 Longs Peak
Rd, Unit A Berthoud, CO 80513
970-532-0123
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
sales tax number isrequired byall mnrracrors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? q Residential ❑ Commercial
If residential, is it: CR Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Restaurant ❑ Other (explain)
❑ Duplex
❑ Retail
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 work Replace a Carrier 13 seer 2.5 ton Air Conditioner
*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 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: -JC `,i, < < C s' '1-c..�..c i Signature