HomeMy WebLinkAbout825 Rumford Ct - Applications/Water Heater - 10/25/201235g��
City of Planning, Development & Transportation
j 281 N. College Ave P.O. Box 580
Fort
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
Q 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. Incomplete applications will not be accepted.
Application #_ I UG�1 l Date . I �� / 7��J / �J 1 U -a10
For ofce use only G-7 T
Jo Si A dr (required)
Va llie f ons ru
ion (labor, materials, profit)
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A COOwner Name Address
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City State
Zip Phone
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A plicant Na Address
City/State
Zip Phone
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ontra Address City/State
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Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? VAere ❑ Report
salas�ulyter& requxedbya/lcontractors.
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Are you paying with your trust account? Tr'Ses ❑ No
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Is this a residential or commercial project? Residential Cl Commercial
If residential, is it; ❑ Single Family Detached ❑ Condo/townhome (single family attached) O Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ ear ❑ Church ❑ Hotel/Motel ❑ Medical office C1 Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes p Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was th building constructed?
If,oricr to 1975, you will need an asbestos assessment to submit with this application.
Description of work
'If lawn sprSk l r/backFlow prevenwmust list licensed plumber, If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins //tense #
Electrician Number 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 constructlon. I know that a
permit is not valid until it has been paid and issued.
Applicant: DraL� 014
Print Name:_. Signature
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