HomeMy WebLinkAbout450 CIRCLE DR - APPLICATIONS - 6/20/2014Jun 20 2014 11:40AM Gary Hooley Heat and Air 9702249198
page 2
Fort Coltins
Planning, Development &Transportation
281 N. College Ave P.O. 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). M Air Conditioning
❑ Demolition Interior non -structure) O Electrical Alteration (not service change) O Gas Lighter O Gas Log
0 Heating Unit 17 Lawn Sprinkler O Mobile Home replacement O Roofing C3 Sewer Line ❑ Photo -voltaic
❑ Ventilation G Water Heater C3 Water Una 0 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.
Date 6/201Z014
Job Site Address (requked)
Value of Construction (labor, materials, profit)
450 Circle Drive
$7 466 98 —1 30 , pO
Property Owner Name Address
City/State Zip
Phone
Tyler Stampfli 450 Circle Drive
Fort Colljns, CO 80524
412-3456
Applicant Name Address
City/State ZIP
Phone
Tyler Stampfli 450 Circle Drive
Fort Collins, CO 80524
412-3456
Contractor Address
City/State Zip
Phone
Gary Hooley Heating & Air, 1314 Webster Avenue
Fort Collins, CO 80524
493-3272
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report?
M Here O Report
sa�sst"MmMrismgdmdbyalfcm6advm
Are you paying with your trustaccourit?
OYes 0No
34734
Is this a residential or commercial project? M Residential 13 Commercial
If residential, Is it: M Single Family Detached 0 Condo/townhorne (single family attached) ® Duplex
C Multifamily (apartment) 17 Garage
If commercial, Is It: 0 Bank ® Bar 0 Church 0 Hotel/Motel C3 Medical office G Office C3 Retail
C3 Restaurant C3 Other (explain)
Is this building 50 years of age or more? ❑ Yes O No dyes, yrw may need to contact HisWrlc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor tb 3975, you w6/need an asbestos assessment to submit *A this app#1 adbn.
Description of work Inslallinafurnace;
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If rust-dme A/C, must list licensed electrician.
S u b c o nt ra c bw s. List Me compaW name or C&y offt Gbllk s l .-n 0
6edridan. Plumber Mechanical H-1654 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 iaws regulating building construction. I know that a
Permit is not valid unto it has been paid and Issued.
Applicant Shell Swanson
Print Name: y Signature
Date i