HomeMy WebLinkAbout5102 Stetson Creek Ct - Applications/Water Heater - 03/11/2013Mar 11 13 11:05a Roberts Heating & Air 9708973151 PA
Fort Collins
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 ❑ 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.
603S0623 Application #
Date 3. I r. 3
9;-w nMfl A lda M/V
Job Site Address (required)
S k5�- C�
Value of Construction (labor, materials, profit)
L LUUk Ai, r<Sc�SaB
5 o y
Property Owner Name
Address City/State L1 I •, nr Zip ��U Phone � ? D
o S 5-o"_ Ci- . 4to) - I; (C
plicant NarRe
i I 1N/� . '�
5
Address City/State Zip Phone R`jJ
>r�4'� I`s� Gv .0r->33
ontractor"
<!
Address City/State Zip ` 0GJ ') Phone '?70
Contractor City of Ft. Colli
des Tax # Are you paying taxes here or by report? ❑ Here �LRepert
Are you paying with your trust account? Yes ❑ No
Sales tax number Rsrequi 6v�c
n& cto�•
Is this a residential or commercial project? R Residential ❑ Commercial
If residential, is it. ❑ Single Family Detached P 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 Ifyes, 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 application.
Description of work W�
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or aty of Ft Collins license #
ElecWdan 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 oonstruoxon. I know that a
permit is not valid until it has been paid and issued.
Applicant-9�
nName , v / Signature , D
I
u \J