HomeMy WebLinkAbout420 S LOOMIS AVE - APPLICATIONS - 3/27/2018...F&City 0f Planning, Development, & Transportation Services
t Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Mein: 970.416.2740 Fax 970.224.6134
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 ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 2>1 CbO oZ oa-1 Date 3 I n 1 1 t
Foroliicae use only
trucction labor, materials, profit)
Job Site Address ilrequlmd) Value of s//r
CT
F.
I N
Property Owner Name Address City/State Zip Phone
m i a0i= Is
Applicant Name Address Gty/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ■ Report
sales tax nUf71ber is required by aD conbacrvrs. - i lb, D Are you paying with your trust account? ® Yes ❑ No
1
Is this a residential or commercial project? ■ Residential ❑ Commercial
If residential, is it: ■ Single 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 50 years of age or more? ❑ Yes ■ No Ifyes, you may need to contact HIstnricPreservadon
If this is for a demolition permit, what year was the building constructed?
Description of work
IffNcAl MW M n
*If lawn spdnlder/baddlow preventer, must list licensed plumber. If first -titre A/C, must list licensed electrician.
Subcontractors: L the company name or City ofRCollins lkense A
Electrild Dn cr _ plumber Medianicai H1309 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:t1M \ lk
Print Name: ,` 1 \ ignature \�"�. Date lI
Revision date 2OW017