HomeMy WebLinkAbout412 Cormorant Ct - Applications/Water Heater - 11/21/2012V& 6*50
City
�� Planning, Development & Transportation
231 ^l. Ccil?ge A✓a P.O. Box =80
t Cock! s
Fort car`. G^,II:+,S, CO 5052-1
Prone 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 Conditior.ing
❑ OemcGtion `:nteror ron-structursi) ❑ Eiec,rcal Alteration (not sai-Ace changer ❑ Gas Lighter ❑ Gas ag
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Phcto-voltaic
❑ Ventilation 'f<'A;ater Heater ❑'Nater Line Cl INooe/Pellet Stove (must be EPA cer+,ifed. provide make, model and
manufacturer)
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # 4311: Z-11-0l0 9 Date 1T/ 1� - a
Foe office use only
Job Site Address ;`r_=quirec: Value of construction (labor, materials, pr, FF!Q
rPrcperr/ Or,rer Narre Address Cit/,.(State
Applicant Name AddreSS Cit/,(State_ Zip Phone
A
rr i
(ion Cract f . Address City State Zip Phone
O;rlYGt'`.��Llliil�Li,
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i Contactor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ZHert ❑ Report
>a/es ta� uyber�^ requr=dbyan arc-3rnr;. Are you paying 'rrith your trust account?� Comes ❑ NO
M
fIs this a residential or commercial project? Residential ❑ Commercial
Ir resident'al, is it: ❑Single Family DRtached ❑ Condo/townhcme (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church Q Hotel/Motel ❑ wledical of`ce ❑ Office ❑ Retail
❑ Restaurant ❑ Other(explain)
Is this building 50 years of age or more? ❑ Yes >fNci hrys, you may need w contac-H/stor(c Preseniat,'on i
�I
If this is for a demolition permit, what year was the building constructed?
1+
lrFr,'or to 1975, you will need an asbesess assessment to submit viith this aoplicatior. I
w
of work Description
P i• c\ �'IPG'Ic��C
*If lairn sprinklerlbackP.ovi 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 .#
E'ac ;clan Plumber "lac! anic21 orpr OC e(
I cerety acknowledge that I have read this application and state that the above information is complete and correct. I agree tc
comply Y0. 311 requirements cor.tainao herein and city crdirances and stata la:vs regulating ccilding ccnstr.ctcn. I know that a
permit is not valid until it has been paid and issued.
Applicant; Print Name:,Signature'
- ! l l l
�r,1 �I—
�Date
100/I00'd 9L56-690-Z0L'0N Xdd AN-7VO INHH03W V119G Nib IZ:OI 00M/ZI0Z/IZ/A0N