HomeMy WebLinkAbout1320 ROBERTSON ST - APPLICATIONS - 6/27/20173/22/2d �z-2o1^.?AMAMFMT TO:19702246134 FRO1%id4jSAVO7234 T-688 P OQl/0a1 : F-10T1
MAIL PERMIT TO HOME OWNER ... MAIL RECEIPT TO FCHA
GI of Planning, Development, & Transportation Services
t �ns Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Mein 970 415 2740 Fax 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). O Air Conditioning
O Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement O Roofing O Sewer One ❑ Photo -voltaic
O Ventilation 13 Water Heater O Water tine 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
mamdecturer)
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application * b 170�3
ForadPAoe aw only
Date (U s 027• /1
30b SM Address (mew) Value of Construction (labor, materials, profs)
Property Owner Name Address Gtv/State Lp Phone
C
Appixant Name Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr #4 Fort Collins, CO 80524 970.484.4552
Contractor Address Gty/State Zip Phone
Fort Collins Healing & Air 208 Commerce Dr #4 Fort Collins, CO 80524 970 484 4662
Contradw City of R. Collins Sales Tax # Are you paying taxes here or by report? O Here ❑ Report
ss�sar rae+rberes+eor +dbrelrmnaacrwx Are you paying with your tnA account? ❑ Yes ❑ No
Is this a reodanhal or al project? denhal O commercial
If r;:= is It 6;i;le Family Detached ❑ Cmido/townhome (single family amiched) I] Duplex
❑ Multifamily (apartment) E3 Garage
If commercial, is lit: ❑ Bank ❑ Bar a Church Cl Hotel/Motel O Medical office 0 Office 13 Retail
❑ Restaurant 13 Other (explain)
Is this btitift 50 yews of age or more? ❑ Yes ❑ No If)lies, yvu may need to conWf HLgWk Arseiwl 7
If this Is for a demolftim permit, what year was the building con5tructed7
Description of work
r I aQ Kc
*If lawn sp bWer/baddbw preventer, must fist licensed plumber. If first dine A/C, must list licensed electrician.
Suboontra Ums. L& tine coirg% y name or Qy of ft Colbns htaw 0
E'b&Uu Plunber Mffhw al H7309 Roder Other
I hereby acknowledge that I have read this application and stale that the above information rs complete and correct. I agree to
own* with all reghdrements contains 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.
print : Jennifer Sepulveda Signature Doha e/22/147
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