HomeMy WebLinkAbout1936 W Lake St - Applications/Air Conditioner - 05/29/2013May 29 13 03:22p Roberts Heating & Air 9708973151 p.1
Fort 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)_)i%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 ❑ Wood/Pellet Stcve (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application #_ • 041"If
For office use only
Incomplete applications will not be accepted.
Date 5 / z q [1 3
Job Site Address (required)
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Value of Construction (labor, materials, preiit)
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Property Owner Name Address
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City Stat�_ n^, Zip
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Phone L -10)
16()52
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A icant Name Address
City/State
Phone q L
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Contractor Address
City/State Zip b b537 Phone 19 7 D)
KOOK-T ' S t likiz
-15 AVE:
CA�) 3�t�-2,33
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here la Report
Saks tax numberisrequhredbya#contractors j J
Are you paying with your trust account?
q Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: 0 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 If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this appkcavon.
Description of work a+
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or C ty of ft Collins license 0
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: ' f
Print Flame: L � N �� 11V � 1 � 4'i Signature ' 4 ,V.)j ��i�' Dates