HomeMy WebLinkAbout513 Affirmed Ct - Applications/Water Heater - 02/26/2013FROM :NCA
FAX NO. :9702299983 Feb. 27 2012 10:50AM P1/1
Fort Collins
Planning, (Development & Transportation
281 N. Ilege Ave P.0. Box 580
Fort Col ns, 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) D Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
• Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
11 Ventilation Water Heater ❑ Water Line ❑ Wood/Pallet Stove (must be EPA certified, provide make, model and
manufacturer .
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # F5(1�300 0LIG Date 'P - 91LP 45 c9_(51(0
For office use only
Job Site Address (requ/red)- -
Value of Construction (labor, materials, profit)
L�tCO
�G
Property Owne me Address
City/State zip
Phone
Applicant a Address
City/State ZIP
Phone
Contractor Address
City/State Zip
Phone q`'b
IC
�3-
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
XReport
Salcstax number IsrequlredbyaUrontractois
Are you paying with your trust account? OKYes
❑ No
Is this a residential or co mercfal project? Residential ❑ Commercial
If residential, is it: PrSingle Family Detached C3 Condo/townhome (single family attached)
13 Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel Q Medical office ❑ office
❑ Duplex
❑ 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 will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or C/ty of Ft Collins license 4
Flectridan Plumber_ _T 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 Nam
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