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HomeMy WebLinkAbout612 ZUNI CIR - APPLICATIONS - 8/16/201608/16/2016 08:03 FAX 970 686 6087 AMERICAN AIR HEATING INC 4 CITY OF FT COLLN 10 001/001 Planning, Development & Transportation City. of /t/l 281 N. College Ave P.O. Box 580 Fort Cottins r'�` =�� Fort Collins, Co 80524 R>✓� ( Phone 970-416-2740 Fax 224-6134 VDU . 5V� 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 ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation RVater 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 # b I �DO �-i' V I C) Date For office use only Sob Site Address (requimed) Value of Construction (labor, materials, profit) le 2- AtAa-); Cir, 1 $ 0 5 Property Owner Name b-4en&_ Address Roc-. u Cty/State 4.iz Zkr', C.ir- Zip FC. °b5 Phone '5z*3-2US Applicant Name Address City/State Zip Phone Contractor Lic # Address City/State Zip Phone %rwerif /J,' rile- #-/ 7AI ,5l� ( r {'as-alrh br . "F Ilf,dS'ar. i1U• 905. 1;y 170 6,9&-&OR� Contractor Clity of R. Collins Sales Tax # 5r Are you paying taxes here or by report? mere ❑ Report Saks tax number is required bya#conba&iis ' Are you paying with your trust account? Oles ❑ No Is this a residential or co)yimercial project? RrResidential ❑ Commercial If residential, is it: C7 Single Family Detached ❑ Condo/townhome (single family attached) 0 Duplex © Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar © Church ❑ Hotel/Motel © Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? 0 Yes M14o If yes, you may need to contact Hlstt c Prewrvat/on If this is for a demolition permit, what year was the building constructed? If prior to 1975, you will need an asbemios assessment to subm/t with this appl/catlon. Description of work &-,24cr, bL) oL4r-r *If lawn sprinkler/backfiow preventer, must fist licensed plumber. If first time A/c, must list licensed electrician. Subcontractors". List the companyname or City ofPt Collins Ik&wa if Electrician r►/' leO(Yee, Plumber Macharural Roofer Other I hereby acknowledge that I have read this application and state that the above information is complete and corrKt. 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: Print Name: v "� ��"""`" �` Signature _,LA_J%�metjf Date 9 -//p ' ��