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HomeMy WebLinkAbout3626 Kunz Ct - Applications/Water Heater - 02/26/201302-26-13;09:05AM; # 2/ 3 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. Application # 131300'ay (P Date For ousts use only Job Site Address (requ/red) Value of Construction (labor, materials, profit) 3Io a 6 Ku m -z- er iter D -* 5-7 S Lie, Property Owner Name Address City/State Zip Phone SANcTu frPTS. 3'73P IGu i-2- CT F4-0-aLunlS Ca 605'a6 4-7o aas-afI& Applicant Name Address City/State Zip Phone Contractor Address City/State Zip Phone P v� PLu .c P01ox i'S& lO/tru t co $0537 1"0 &&3-34fq Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?ere ❑ Report Sales iwnumbwls requGrdbyoff conbachus. Are you paying with your trust account? Yes ❑ No Is this a residential or commercial project? Cl Residential Xcommercial 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 O Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to conta&Hlstorlc Preselvatlon If this is for a demolition permit, what year was the building constructed? Ifplfor to 1975, you w11/needan asbestos amzn;,enttosubmit with Misapplzwborz Description of work /N5T04LrL 4t7 6A[J.-tlrJ i-4J iJZr Ff 1q-T ye *If lawn sprinkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Ustthecompany name or©tyoFRCol11ns11aense# Electridan Plumber Mechani al 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.. x know that a permit is not valid until it has been paid and issued. Applicant: PrintName:SALA--E KcS8EL(3 ctG Signature Date -2 /;t to /1 '3