HomeMy WebLinkAbout1637 Tanglewood Dr - Applications/Water Heater - 03/01/201302/28/2013 15:05 9704938020
PAGE 01/02
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). Cl Air Conditioning
❑ Demolition (interior non-structural) O Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing O Sewer Line ❑ Photo -voltaic
❑ Ventilation X Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the ap Iication. Incomplete applications will not be accepted.
Application # t7yl =_ Date 3✓�
For office use only-
o�S-00', '
Sob Site Address (required)
Value of Construction (labor, materials, profit)
1637 Tanglewood Drive
$995.00
Property Owner Name Address
City/State Zip
Phone
Rebecca Torrejon 1637 Tanglewood Drive
Fort Collins, CO 80525
227-3264
Applicant Name Address
City/State Zip
Phone
Bershinsky Plumbing & Heating P.O. Box 679
Fort Collins, CO 80522
493-4355
Contractor Address
City/State Zip
Phone
Bershinsky Plumbing & Heating 1425 Lawton Lane
Fort Collins, CO 80524
493-4355
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? O
Here ❑ Report
Sales tax number is required by all contractors_
21177
Are you paying with your trust account? ❑
Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ 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 LO Other (explain)
Is this building 90 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 bullding constricted?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Replace water heater
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: list the company name or City of Ft Collins license #
Electrician Plumber Ml!:143 Mechanical Roofer Other
I hereby acknowledge that I have read this application and slate 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: Hill BershiriftSignature