HomeMy WebLinkAbout412 Robin Ct - Applications/Mechanical - 04/29/2019 (2)U-ty U$ Planning, Development & Transportation
' i 281 N. College Ave P,O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to bit used to apply for the following permits only (check all that apply). WAir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑Gas Lighter ❑Gas Log
'Heating unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑Sewer Line El Photo -voltaic
manufacturer).
❑ Ventilation ❑Water Heater ❑Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
Complete all applicable information on the application. Incomplete applicat•
Application #NL10 2'b 23
For office use only v, CI F l
Job Site Address (r052c
equired)4I2_14bIAU.
'uen�i aYS DnS 44121RDbin Ct. Fb
Property Owner Name Address
n
Applicant Name Address
- I Contractor
Address
Contractor City of Ft, Collins §ales Tax #
n T
S es to mb"' r is required by all contractors,
t
Ions will not be accepted,
Date `P/ 29 / 191
Value of Construction (labor, materials, profs )la�y211
II WSW 0 8 652& '72D - 4-7D - 7�9S
City/State Zip Phone
LovtlGnd, Co 8 el'lt7-qq—yqy
City/State
City/State
.5954 Lockhicd ht.
Phone
Phone
Are you paying taxes here or by report? ❑ Here X, Report
Are you paying with your trust account? Yes ❑ No
Is this a residential or c mmercial project? �J Residential 17 Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
14 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (exp n)
Is this building 50 years of age or more? ❑ Yes No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was th building constructed? _
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber, If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or city of Ft colllnslicense �X
ElectricianPlumber
Mechanical__ Roofer_Other
I hereby acknowledge that I have read this application and state that the ab�nformation 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 hot valid until it; has been paid and issued,
PrinAppt ant: �D S �,L,
Print Name: 1
—may— Signature �-yI �� ,�j 2G 1
J �---t_ Date 1