HomeMy WebLinkAbout412 Towhee St - Applications/Water Heater - 01/07/2013J
F®rtCiCollins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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
❑ 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 IUZWater 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 # 'b?200Q(9(0 Date
For office use only
Job/Site Address (required) Value of Construction (labor, materials, profit]
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Property Owner Na a
Address
City/State
. Zip
Phone
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Applicant Name
Address
City/State
Zip
Phone
Contractor Uc #
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Address
City/State
Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here 07Report
Sales tax number is required by all contracwm
Are you paying with your trust account?
87Yes ❑ No
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Is this a residential or commercial project? 07Residential .•..: 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 ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact H&Wj cPreservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you wi// need an asbestos assessment to submit with this appiicagon.
Description of work ,,, l ?.(� C-7e-, 1< e4 jf'.-
*If lawn sprinkler/bacifflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List dre company name or Gty of Collins license #
Electrician Plumber 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 Name* i r zip A0 15 vre
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