HomeMy WebLinkAbout1832 Beam Reach Pl - Applications/Water Heater - 12/05/201212/05/2012 10:10 9704938020 PAGE 01/02
City of
Cottins
Planning, Development 8t 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 X 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 # O Date �� S
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
1832 Beamreach Place
$1,050.00
Property Owner Name Address
City/State Zip
Phone
Youle Realty 3307 S Col a Avenue
Fort Collins, CO 80525
204-1045
Applicant Name Address
City/State Zip
Phone
Bershinsky Plumbing & Heating P.O. Box 679
Fort Collins, CO 80522
493-4355
Contractor I Address
City/State Zip
Phone
Bershinsky Plumbing & Heating 1425 Lawton Lane
Fort Collins, CO 80524
493-43SS
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑
Here ❑ Report
Sales tax number Is required by all contractors.
Are you paying with your trust account? ❑
Yes ❑ No
21177
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, Is It: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
. ❑ Multifamily (apartment)'❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Offlce ❑ Retail
❑ Restaurant ❑ Other (explain)
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 the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Replace water heater
*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 Collins license #
Electrician Plumber 1NP-143 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 paid and issued.
Applicant:
Print Name: Bill Bershinsky Slgna are Date _December 5. 2012