HomeMy WebLinkAbout3036 Dunbar Ave - Applications/Water Heater - 02/12/2013City of Planning, Development & Transportation
�� 281 N. College Ave P.O. Box 580
t Collins Fort Collins, CO 80524
Phone 970-41&2740 Fax 224-61M
OVER-THE-COUNTER PERM17S 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 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information ontheapplication.
.Application # 45 `5 Qy� L -
ForbfTiie iaw only
Incomplete applications will not be accepted.
Date
]ob Site Address (required) Value of Construction (labor, materials, profit)
3613 tO 10tt" l eLr { �DO
Property Owner Name Address
City/State
. Zip
Phone
F?oy lc- 3v3&
Fc�z
Applicant Name Address
City/State
Zip
Phone
Contractor Lic # Address
City/StateTip
Phone
/�
e .S'r )-/esfan43'-9
p7p-iy,rj 131 IV. mz,n K t
Ff /'vS ee-,
S-05 -1
y6-`r- ZGor
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here 0711eport .
Sales tax number isrm7 red by allmnbacfirs
Are you paying with
your trust account?
EPYes ❑ No
ZZ E;Lz
Is this a residential or commercial project? M711esidential 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 So years of age or more? ❑ Yes ❑ No rf yes, you may need to contact Historic Preseruabon
If this is for a demolition permit, what year was the building constructed?
Ifprfor to 1975, you WI/ need an asbestos atsse ent to submit widr thisappl/cation.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time AJC, must fist licensed electrician.
Subcontractors: List the company name or City offt Colin 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-Ficit It I 'p she] i S on Sign i 2,110 7z; %