HomeMy WebLinkAbout3530 Kingston Cir - Applications/Furnace - 04/12/2013Apr 10 13 02:19p Roberts Heating & Air 9708973151 p.2
Fort Collins
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) 0 Gas Lighter ❑ Gas Log
n Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ 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 # 151301 ce9�
For office use only
Date 4 A u/ / 3 L4 —1 o_>
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State
Zip
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City/State
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Contractor Address
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Phone
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Contractor Gty of Ft. Collin les Tax # Are you paying taxes here or by report? ❑ Here J9 Report
Sales tax number tsrequired by al/ contractors, Are you paying with your trust account? ® Yes
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❑ No
Is this a residential or commercial project? P Residential ❑ Commercial
If residential, is it: q Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes C l No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ypnor to 1975, you will need an asbestos assessment to submit with this application.
Description of
*If lawn sprinkler/backfiow preventer, must list Jicensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname 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. \
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Print Name: ) � n"�� Signature �f� r � Date s( ,/10/ i3