HomeMy WebLinkAbout1235 Juniper Ct - Applications/Water Heater - 10/10/2012Fort Collins
Planning, Development & Transportation
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 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 ❑ Sewer Line . ❑ Photo -voltaic
❑ Ventilation `LDWater 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. �G
Application # l aD (0083 Date _ 64A\a "
For office roe only
Job Site Address (requnegJ
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
0
Applicant Name Address
City/State 27p
Phone
Contractor Address
City/State Zip
Phone
a
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
50 Report
Sales tax awnberisregrdredbyall avradom
Are you paying with your trust account? XYes
Q No
Is this a residential or commercial project? 4Itesidential ❑ Commercial
If residential; is it: mingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
L3 Multifamily (apartment) ❑ Garage
If commercial; Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical. office ❑ Office ❑ Retail
❑`Restaurant . ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyies, you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 197S,, you will need an asbestos assessment to submit with this appllcatlon.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: LI& the company name or Gty of Ft Collins license .f
Electrician Plumber
Mechanical Roofer Other
I hereby acknowledge that I have read this application and state thatthe 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:` \"CD�Q����+c�t� SignatureDate t
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