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HomeMy WebLinkAbout1408 Reeves Dr - Applications/Air Conditioner - 10/28/2014Sep 1614 01:28p Roberts Heating & Air 9708973151 PA Planning, Development & transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 22+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) © Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log O Healing Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application L1 1 D-12q Date _ l o Sob Site Addrem (required} Value of Construction (labor, materials, profit) Property Owner Name Address City/State �} Zip Phone t> Applicant,Name Address ❑LY/-Stabe zip Phone t Conttacbor Ad ress Crty/S Zip Phone c t LRI Contractor City of Ft Collins Sai ax # Are you ying to here or by report? Q Here ❑ Report Sales taxaumberisreaml edbyall mnbaCtors Are you paying wb your trust account? V Yes ❑ No Is this a residential or commercial project? Residential ❑ Commercial If residential, is it: $[Single Family Detached ❑ Condo/bownhome (single family attached) ❑ Duplex Multifamily (apartment) ❑ Garage If commercial; is it: ❑ Bank ❑ Bar GI Church ❑ HoteMbel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other {e)plain) Is this building 5o years of age or more? ❑ Yes 17 No If ya, you may need to cvntactKt,torlcPresermWn If this is for a demol€bon permit, what year was the building constructed? Ifpeor to Z975, you will need an asbestos assessment to submit with bits applicvbbn. Description of work *If lawn sprinkler/backflow preventer, must fist licensed plumber. If first-time A/c, must list licensed electrician. Subcontractors: List the company name or OW of Ft cfllAns Bcense # Electrician Plumber v4ctenicai Roofer Other I hereby acknowledge that I have read this application and state that the above Information is complete and corret:t. 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. Appltcartt:l Si8 A Date Print Name. +� n 1S�