HomeMy WebLinkAbout2815 Dixon Creek Ct - Applications/Furnace - 08/23/201108/26/2011 10:04 9708973151
Fort Collins S3
ROBERTS HEATING& AIR
Planning, Development &
281 N. College Ave P,O, Bc
Fort Collins, CO 80524
PAGE 01/01
Transportation
x 580
Phone 970-416-2740 Fax 22.4-6134
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) fJ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home. replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation O Water Heater ❑ Water Line O 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 # ( 3- LTC) Date- S 9 a 3 / P I
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
°
Property Owner Name Address
City/State Zip
Phone
e
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State ZIP
Phone
+�
N L.-)
Contractor City of Ft. Collins ales Tax #
Are you paying taxes here or by report? M Here
❑ Report
sn/w tax numtvr is mgviudby all cono-7avis.
Are you paying with your trust account? ❑ Yes
0 No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: NJ Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 13 Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 2 No If yes, you may need to contactHistoric Preservation
If this is for a demolition permit, what year was the building constructed?
IFprior to.1975, you w/i/ need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: UstMecompany name orCItyofHCollins 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: �A�� g A & (i Date
Print Name: '� ( SI nature