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HomeMy WebLinkAbout6231 Eagle Ridge Ct - Applications/Water Heater - 10/23/2012OCT-23-2012 09:24 From:Rllen Service City of ,.Fort Collins 970 484 4448 To:92246134 Pa9e:10/13 Planning, Development & Transportation 281 N. College Ave P.Q. Box 580 Fort Collins, CO 8OS24 Phone 970j116-2740 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). O Air Conditioning ❑ Demolition (interior non-structuran O Electrical Alteration (not service change) ❑ Gas Lighter O Gas Log O Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing O Sewer Line „ ❑ Photo -voltaic O Ventilation Valor Heater ❑ Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer Complete all applicable )information on the application. Incomplete applications will notr be accepted, Application #y i dou I lqLe Dace / Aar ofte use Only Q<_(v ) Job Site Address N Pr +�ioperty Owner Name V l , Aire1 raY Applicant Name ' 1S4f t i f1H A( k. Value of Construction (labor, materials, profit) c.o �a5a a�sa o0 Address City/State Zio Phone n� Co I- No Address City/state Zip Phone Contractor Address City/state Zip Phone AA faAW14 o51R14741-q'9411 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? O Here f(Report sores tar number a reou red by aff conhwrors. Are you paying with your trust account? )K Yes O No LSLCI LS2 Is this a residential ZLSynmerdal project? identlal 13 Commercial 1t residential, is it: Ingle Family De ❑ Condo/townhome (single family attached) © Duplex Multlfamily (apartment) 0 Garage I If commercial, is it:' Q Bank 0 liar ❑ Church ❑ Hotel/Motel © Medical office • ❑ Office ❑ Retail 0 Restaurant ❑ Other (ex aln) Is this buliding SO years of age or more? O Yes No If ye�;, you may need to contact H.CQwk Preservation If this is for a demolition permit, what year was the Millding constructed? 1f prior to 1975, you will need an asbestos assess 107t lU subrWf w1th th/s appdcabbm Description of work AAPAJ r Q ; ,- *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must W licensed electrician. Subcontractors: L/stthe company name orCity ofRColinslicense O Electrician Plumber Mechanical Roofer other I hereby acknowledge that t have read this applIcation and state that the above Information is complete and correct. 1 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: hQr�l 1 1 lln I1 ` Print Name: , Signatur Date (a��3 "