HomeMy WebLinkAbout4349 KINGSBURY DR - APPLICATIONS - 10/24/2012Oct 24 12 07:51 a Swan Heating and Air
9706130826 PA
Application # 12 Dl Q D
planning, Development & Transportation
281 N. GDRege Ave P.O. Box 580
Fort Collins, M 80324
Phone 470.416-2740 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). ❑ Air Conditioning
❑ D 6m6fition (interior non-shvctuml) ❑ Electrical Atteralion (not service change) ❑ Gas Lighter ❑ Gas Log
91heating Unit ❑ Lamm Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voltalc
❑ Venbiaffon 0 Water Heater 0 Water Line ❑ WoodPaliet Stove (must be EPA certified, Provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
"Date , f CU • Z L-4 - Z O l Z to � C) Cl
Sob StiUe Address (requirEd)
lfalue of Construction Qatar, materials, POOR)
Property owner me Address
City/State
Zip
Phone C(It)
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Applicant Name AddraVs
City/State
Zip
Phone
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Phone Cn0
Contactor nr��/yyAddress
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Contractor Gty of Ft !fins Sales Tax #
Are you paying faxes here or by neport7 ❑
Are you paying with your trust a000trnt? i9'Yes
13'Ieport
❑ No
sates tWrxffAae sre�i d bYaya nhacm s
Is ttds a residential or commercial Project? �esiderrtial ❑ Commercial
if rEsdelrtfal, is it; ❑EYt ng� Y ��ed ❑ Garage
(single family attached ❑ DuP1ex
If Commercial.. Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Ret3fi
p Restaurant ❑ Other(explafn Pnvabon
Is this !wilding 50 years of age or mom' the yes,)wistu ma naed to H6wifc
If th"t4 is for a 5, ym Pion peraneed an
a t omibmit wolf this applkatwon.
IfArfor m I975 yot! will ne�edan asbestos
Desc*uon of work
*If lawn sprinkler/bad6fow prevents, must list licensed plumber. If first --time VC, mast list Ifoarsed eiedrldan-
Subomt aMlIx !15t the avWnynmw crCdyofftCol#'wffD nw
[3ectrio
Phrrnber Medjmtcar Roofs _ Other
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i hereby admowte�3e that I Five read appr�tion and slate that the above hrfomiation is complel a and oorreclI�gr � a
comply %,M all requlrenvmM contained herein and city ordinances
and slate laws roJu n4 building eonstnrction
permit is not valid urdl It has been paid and bsued. -
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