HomeMy WebLinkAbout5201 Fox Hills Dr - Applications/Mechanical - 03/01/2013Feb 2513 10:41 a Roberts Heating & Air 9708973151 p.1
� ort of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, 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 ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 0 Water Line ❑ Wood/Peliet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete ail applicable information on the application. Incomplete applications/will not be accepted.
Application# F)i3ao9a9 Date_ 2i7,"�9
For office use only
Sob Site Address (required)
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Value of Construction (labor, materials, profit)
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Property Owner Name
Address
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Phone c110
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A plicant Na
Address
City/State Zip
Phone of i D'
Contractor
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Address
4-15
City/State Zip �3�
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Phone q-10
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Contractor City of Ft. Collins, les Tax #
Are you paying taxes here or by report? ❑ Here
P Report
Sales tax number isrequirrdbya/lZZmnhac7ors:
Are you paying with your trust account? PJ Yes
❑ No
Is this a residential or commercial project? 4 Residential ❑ Commercial
If residential, is it: n 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 So years of age or more? ❑ Yes ❑ No If 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 rail/ need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician 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: 1�
Print Name: C-I nt0y V'%rf-I h {-1-Y Signature
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