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HomeMy WebLinkAbout1949 Promenade Way - Applications/Water Heater - 11/06/2012City Of Planning, Development & Transportation F%/ 281 N. College Ave P.O. Box 580 ort Collins 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 O 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 % Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Application # � a bl-fko�ac� For office use only Incomplete applications will not be accepted. Date 11 l ©lo h2 lob Site Address (required) rValue of Construction (labor, materials, profit) ��'-}�•1 7t-o�c.�c��.e. ���•-i� �r� Cam,\\ n� Property Owner Name Address City/State Zip Phone 19 q-1 C`k\,, 8ZrD 2.(, (` 10) 2-9 0-833 Applicant Name Address City/State Zip Phone Contractor Lic # Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report Sales tax number is required byall conbactors Are you paying with your trust account? ❑ Yes ❑ No Is this a residential If residential, is it: sidential ❑ Commercial ❑ Condo/townhome (single family attached) ❑ Duplex ❑ 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 'ANo 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. or commercial project? 36 'O Single Family Detached ❑ Multifamily (apartment) Description of work E7 X *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 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: 14C�V-r� An�yr�� Signature 64 cax" i 1 U2 2 Date