HomeMy WebLinkAbout2203 Fossil Creek Pkwy - Applications/Air Conditioner - 06/26/2013Jun 27 13 06:32a Roberts Heating & Air 9708973151 p.1
city of
Fort Collins
Planning, Development&Transportation
281 N. College Ave P.O. Box 581)
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). �814ir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement o 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 # 0
Fora1Ace use only
Sob Site Address
Property ner Name
gal of rlt Name
Contractor
Ads'
�— Address
Address
Contractor city of Ft Collins Sales Tax #
5.a'es tBxnumberisregWedbyaumnvacrarS' 2- i
Date L I ZU 11 3
Value of Construction (labor, materials, profit)
hM1 2
City/State`�1, Zip
� '� � Phone
W'LC.-iTY�-,�i. ����`Fi� V!Z••%,I10
City/State - J Zip Phone ff -1
�oLeza.,�li� � �'S3� 13R7-z337
City/State Zip bb53-7 Phone (9 7 D]
Are you paying taxes here or by report? ❑ Here 0 Report
Are you paying with your trust account? Id Yes ❑ No
Is this a residential or commercial project? MResidential ❑ Commercial
If residential, is it 'Gil Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medicai•office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need tbWlMaCCHistOdC 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 application.
Description of
*If lawn sp inkler/badctiow preventer, must list licensed plumber. if first-time A/C, must list licensed electrician.
Subconteaetors: List Uwe Company name or G'ty of Ft Collins /!tense #
Mechanical Roofer Other
Electrician Plumber,
I hereby acknowledge that I have read this application and state that the above Information is complete and correct I agree to
comply with at requirements contained herein and city ordinances and stale laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant.
Print Name: C I �� i 1�i _ Signature
Data, ��' ,r1)