HomeMy WebLinkAbout3019 Sumac St - Applications/Air Conditioner - 07/31/2018City of Planning, Development, & Transportation Services
Fit 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), IN 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 # t)1q)o U? a SO Date
For ofisae use only
lob Site Address (required) Value ofFonstruction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone W
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Applicant Name Address City/State Zip 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 R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ■ Report
sales tax number lsrequired byall contractors rbMD Are you paying with your trust account? ■ Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ 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 ❑ Other (explain)
Is this building SO 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?
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractorss the company name or City of Ft Collins license 0
p�List
Electrician On llA Plumber Mechanical H1309 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: yL�-�IIt
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Print Name:—I� l Signature ! Date
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Revision date 202017