HomeMy WebLinkAbout3760 Ashmount Dr - Applications/Air Conditioner - 06/30/2018Fort Collins
Planning, Development & Transportation
281 N College Ave P 0 Box 580
Fort 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) EI Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ 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 information on the application Incomplete applications will not be accepted
Application # ��`q�C)
For office use only
Date 06/30/2018
Job Site Address (required)
Value of Construction (labor, materials, profit)
3760 ASHMOUNT DR
$4,370 00
Property Owner Name
Address City/State Zip
Phone
ADAM FOWLER
3760 ASHMOUNT DR, FC CO 80525
970-213-4362
Applicant Name
Address City/State Zip
Phone
Contractor
Address City/State Zip
Phone
NORTHERN COLORADO AIR INC
812 STOCKTON AVE, FT COLLINS CO 80524
970-223-8873
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report?
9 Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
M Yes ❑ No
26862
Is this a residential or commercial project? El Residential ❑ Commercial
If residential, is it El 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 9 No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application
Description of work REPLACE AC
*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 KARENA HUNTWORK Signature
KARENA
HUNTWORK
Op IN 9M A KARENAHUNNA
�m KARENN Hl1NMARK
"KA ENAH®NC GR FCO Date 06/30/2018
Wt ]0 89 61 S 9 0)Yp'