HomeMy WebLinkAbout228 N Loomis Ave - Applications/Air Conditioner - 01/04/201201/05/2012 09:44 9708973151 ROBERTS HEATING& AIR PAGE 01/01
Ci Of
F P
crtCollins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, Co 80524
Phone 970-416-2740 Fax 224-6134
OVER-' HIE -COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ®Air Conditioning
O Demolition (interior non-structural) CI Electrical Alteration (not service change) O Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler O Alobile Home replacement ❑ Roofing O Sewer Line ❑ Photo -voltaic
❑ Ventilation O 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 #
For office use only
]ob Site Address (required)
2-2- LWr
Property Owner Name Address
icant Name _ Address
Contractor Address
Contractor Oty of Ft. Collins -Sales Tax #
Sales tax number Is required by all contractors.
Date
Value of Construction (labor, materials, profit)
1 3- 5 0 c"
City/State Zlp f Phone
_Lt
City/State Zip Phone
City/State ZIP Phone
Are you paying taxes here or by report? 10 Here ❑ Report
Are you paying with your trust account? D Yes M No
is this a residential or commercial project? ® Residential 0 Commercial
If residential, is It: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ Bar 1] Church ❑ Hotel/Motel 0 Medical office ❑ Office ❑ Retail
❑ Restaurant 17 Other (explain)
Is this building 50 years of age or mona7 C1 Yes 111111 No If yes, you may need 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 application.
Description of work
*If lawn sprinkler/backflow preventer, mu:;t list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Fledxlcian 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 p„id and issued. n
Applicant: .
Print Name: 21:e-Signature 'r,N Date -