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HomeMy WebLinkAbout4721 OLT CT - APPLICATIONS - 5/19/2017May 19 2017 05'48AM Gary Hooloy HVAC 9702241108 pegs 2 Cit of oFi Collins Planning, bewloprrant S Transpoftdon 261 N. College Ave P.O. Box 580 Fort Collins, CO BOS24 Phone 970-416-2740 Fax 224-f1134 OVER-wTHE-COUNTER PERMITS ONLY This applloatlan N to be used to apply for the following parmtts only (oheok all that apply), M Air Condltloning G Demolition Qnterlor non-structurQ 0 Electrical Alteration (n6t servk:e change) O Gas Lighter C1 Gas Log O Heating Unit 0 Lawn Sprinkler Q Mobile Home replacement O Roofing G Sewer Line Cl Photo -voltaic G Ventilation O Water Heater G Water Line 17 Wood/Pellet $love (must be EPA certified, provide make, model and manufacturer). Complete all applicable Inlormetlon on the application. Inobrnplets applications will not be accepted. Application # (-) i qQ AwORM &W 019Y Date 5/19/2017 30b SRO Address (rmzftd) Value of Cpnetructiorr (labor, materials, pro61t) 4721 Olt Court S3,141.00 Property Owner Name Address City/State cep Phone Dade Howard 4721 Olt Court tort Collins, CO 80528 232-5034 Applicant Name Address Clry/5tate Zip Phone Darla Howard 4721 Olt Court ort Collins, CO 80526 232-8034 Contractor Address awstate Zip Phone OC Shortridge dbe Gary 1314 Webster Avenue Fort Collins, CO 80524 493-3272 Contractor City of FL Collins Sales Tax # Are yolr paying taxes here or by report? 0 Here G Report Sallee lax n MW*reQY1Md bYj?#d rrbaarevs Are yo(1 paying with your trust account? 0 Yes 17 No 34734 Is this a residential or commercial project? © Residential 0 Cornmerclal If residential, is It M Single Family Detached Q Condo/town ono (single family attached) Q DWplex 0 Multlfamlly (apartment) 0 Garage If commercial, Is It: Q Bank 12 Bar Q Church 0 Hotel/Motel ; G Medial office 0 Office Q Retall i2 Restaurant 0 Other (e)plaln) Is this bulidlng 50 Year; of all or more? 0 Yes O No VM you t wy fmad to cwA&c'tff/sblyde RreserAN on If this Is for a demolltlon perm[X, what year was the building con umad? b'pniar b, .07% Aw wX ImW an arbanvw anumment to sublra th& appAwtkw. Description of work JWLUo A/C aggla l WM 2.5 ton oondanaina unk *If lawn sprinkler/baddfow pmventer, must list licensed plumber. If fl' dme A/C, must list licensed electrklan. rs mp SubcontractoW the eaaW name or CYgr of R CbRns #mnsr 6edrltlan Plumber Ao*r Other I hereby acknowledge that I have read this application and state that tale above Information Is complete and correct. I agree to comply with all requirements cordalned herein and city ordinances and Rate laws regulating building construction, I know that a permit In net valid until It has been paid and Issued, Applicanti Shell S Print Nameywanson Signature Date � 11-7