HomeMy WebLinkAbout1025 Oxford Ln - Applications/Water Heater - 02/27/2013Hahn plumbing
970-493-5325 p.1
FCiof
ort Cotlins
Planningr 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). El Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing Ci Sewer Una. 0 Photo -voltaic
Q Ventilation PZWater 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 # 8 �3oas�a Date • �— ��2"1
Far office use only
Job Site Address (regVk2d)
Value of Construction (labor, materials, profit)
0' � X; u' 1
f n e
C?f 11,61
Property Owner Name`
Address
Cltyistate Tip
Phone '
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Applicant Name•
GtyJState -�' Zip
Phone
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Contractor J
Address
Clty/State Zip
Phone
r. J
Contractor City of Ft Collins S s Tax # ()'JP- / $
Are you paying taxes here or by report? ❑ Here
gReport
Sates tax number isregVmdbyall cm6actom
Are you paying with your trust account? XYes
❑ No-
itn')`7a
Is this a residential or commercial project? El Residential Commercial
If residendal, is it: ❑ Single Family Detached ❑ Condoltownhome (single family attached) • C1 Duplex
..Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank 0 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office Q Retail
❑ Restaurant E3 Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, youmayneed to coniactHfstofkPreservalion
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 w9h this application.
of work
*If lawn sprinklerlbackfiow preventer, must list licensed plumber. If first-time AJC, must Ust licensed electrician.
Subcontractors: Ustthe company name orGtlofftCollrnsIkense4
Electrician Plumber Mechanical Roofer
other
I hereby acknowledge thatl have read this application and state that the above Information Is complete and eorrecL i agree to
comply with all requirements contained herein and city ordinancesand State laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant e )) <
Print Name:_ l � �Lt iC • '\ O rsignature-S/1 ,,. ' ' ' Dated