HomeMy WebLinkAbout414 Tedmon Dr - Applications/Furnace - 10/24/201110/24/2011 13:36 9708973151 ROBERTS HEATING& AIR PAGE 01/01
Planning, oevelopment & Transportation
City of 281 N. College Ave P.O. Box 580
Collins Fort Collins, CO80524 Phone 970-416-27402740 Fax 2246134
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 O Sewer Line ❑ Photo -voltaic
0 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 # I& Worl �X \� Date �� —
For office use only 2 .50
Job Site Address (requirea9 Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applican ame Address City/State Zip Phone
Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
sales tax number is rcgwres by a0 cion&%Wty.
35 -
Are you paying taxes here or by report? M Here ❑ Report
Are you paying with your trust account? ❑ Yes ® No
Is this a residential or commercial project? 19 Residential 11 Commercial
If residential, is it: P Single Famlly Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: 0 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
[I Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes IF No if yes, you may need to contact HistorIc Presetvat/on
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you w/ll need an asbestcs assessment to submit with this app/lmdon.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subconti acto rs: List the company name or Gty of Pr Collins license #
Electrician Plumber. Mechanlcal 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: �—
Print Name: Signature Date 9 0 d (f -1)
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