HomeMy WebLinkAbout4213 BEAVER CREEK DR - APPLICATIONS - 6/23/201606/23/2016 07:22 FAX 970 686 6087 AMERICAN AIR HEATING INC 4 CITY OF FT COLLN R 001/001
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OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). lid Air Conditioning
❑ Demolition. (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
ErHeating Unit , ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
0 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 # date
For office use only
Sob Site Address (mquired) Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State
VGC CcSSk bC
Zip
�C, $d5.x
Phone
�- 583
ADDI cant Name Address
City/State
Zip
Phone
Contractor Llc #• Address City/State Zip Phone
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6e M 5-b ! i� b'�r��h �r,'i �,e Sty , L'0. 3 $7 $
Contractor City of Ft. Collins Sales Tax # IY- Are you paying taxes here or by report? Mere ❑ Report
sales tax numbwis required by all contractors ` �`� Are you paying with your trust account? des ❑ No
Is this a residential or commercial project? M(Residential 0 Commercial
If residential, is it: IrSingle 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? 0 Yes dtvo Af yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work IRS}• FL"{n4�� A JC
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors, lUst the company name or CV of Ft Collins license #
Electrician n ►add -T e C 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; �c (/
Print Name: �` '` r `r Signaturelf,�9 G Date � 23//&