HomeMy WebLinkAbout621 PEYTON DR - APPLICATIONS - 5/1/201505/01/2015 08:23 FAX 970 686 6087 AMERICAN AIR HEATING INC 4 CITY OF FT COLIN 10001
City.of planning, Development & Transportation
F6r6 Cotl�ns For N. Collins,College Ave P.O. Box 580
r Fort llins, 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit O Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -volt c:
❑ Ventilation I(WaterHeater ❑ 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 # Date
Foroflire use only
Job Site Address (required) Value of Construction (labor, materials, profit)
CeA t 'Pe 46eri
Property Owner Name
Address
City/state
Zip
Phone
Tom ',r 5AQ,3.J X>vbeck
4 Al ra
ac'J Dr•. AC,
S05AS
yZo- 3:z%
Applicant Name
Address
City/State
Zip
Phone
Contractor Lic #
Address
City/State
Zip
Phone
rr rrf Qar /air > #-/ r-;9
5-(o i l : F W,.dsur LO.
go510
17v &W&D?(W
Contractor Gty of Ft Collins Sales Tax #
3��`�/
Are you paying taxes here or by report?
ITHere ❑ Report
Saiesbxnumberisrequfretlbya//cnntracm�s
Are you paying with your trust account? des ❑ No
Is this a residential or commercial project? IrResidential ❑ Commercial
If residential, Is it: M. ingle Family Detached 0 Condo/townhome (single family attached) 17 Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, Is it: 0 Bank E3 Bar 0 Church 0 Hotel/Motel 0 Medical office 0 Office 0 Retail
❑ Restaurant 0 Other (explain)
Is this building 50 years of age or more? ❑ Yes 111'1%lo Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, whatyear was the building constructed?
IPpiior to 1975, you will need an asbeslras assessment to submit mth this application.
Description of work We !t t /heva Aea.�r-
*If lawn sprinkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontr
ta
�ctors! List Me compimyname or Gty ofR Col!/12F lka se #
mectridan W ► lafe(e e r Plumber Meftnical 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; b/i'Yli`Gtr[.[. if
printName. Signature
Date