HomeMy WebLinkAbout4619 Crest Rd - Applications/Water Heater - 11/28/2012Dec 30 12 03:55p Francisco Manzano
9705061686
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City o+
Fort CoWns
Planning, Development & Transportation
281 N. College Ave P.O. Box 580 et
Fort Collins, CO 80524 , A 43
Phone 970-416-2740 Fax 224-6134 �+�
OVERmTHE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (Check all that apply). ❑ Air Conditioning
❑ Demolition (interior nonstructural) EI Electrical Altoration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit El Lawn Sprinkler ❑ Mobile Home replacoment ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation KWator 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 # f 12 0 r! / co -7 Date
For office tam only
Job Site Address (required) Value of Construction (labor, materials, profit)
C_r,' 51` 8 � --
Property Owner Name Address City/State Zip Phone
cat - t} Jell- -,1 619 CrPaf iE��/ /,' 0'7 L 77 1 "7�I
Applicant'Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Cisco b;2925 16/itzati Pnfio q- �-z -7o2l
Contractor City of Ft. Collins Sales Tax # re you paying taxes here or by report? CRlbere ❑ Report
S81b Lmnumbe hvmquiredbyaaconfraabm Are you paying with your trust account? ❑ Yes i' -Wo
Is this a residential or commercial project? Mesidential ❑ 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 ❑ Office 13 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 wr// need an asbestos assessment to submit with this applrcah'on.
Description of work
*If lawn sprinkler/backHow, preventer, must list licensed plumber. If first-time A/C, must list licensed electridan.
Subcontractors: Ust the company name or City of Ft Collins licen-x At
Electrician Plumber Mechanical Roofer
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 requlating building construction. Y know that a
permit is not valid until It has been paid and issued.
ApplicarM
Print Name: [KART Signature _ Date fI /1��
`70
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