HomeMy WebLinkAbout7245 Fort Morgan Dr - Applications/Water Heater - 08/21/2012F rt collin5
Planning, Development & Transportation
281 N. College Ave P.O. Sox 580
Fort Collins, CO 60524
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
❑ 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 A"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 0-�v 50 �e I
For office use only
lob Site Address (required)
Date 2 - ` 3.5
Value of Construction (labor, materials, profit)
Property Owner Name
Aess
City/State Zip
Phone
5 1
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone �l
Contractor City of Ft. Colli
Sale Tax #
Are you paying taxes here or by report?
,Here El Report
Ef —No
Sales tar number&M47viredbyall
ctom
Are you paying with your trust account?
❑ Yes
Is this a residential or comm rcial project? ,Residential ❑ Commercial
If residential, is it: , _ mgle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ 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? 0 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 will need an asbestos assessment to submit with this applrcation.
Description of
*If lawn sprinider/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of R C011ins license #
Electrician
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 Names
Date /) �� f
OR
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