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HomeMy WebLinkAbout3715 Shallow Pond Dr - Applications/Water Heater - 03/21/2013MAR-15-2013 15:26 From:Allen Service 970 484 4448 To:92246134 Pa9e:9/13 City Of fort Collins Planning, development & Transportation 281 N. College' Ave P.O. Box 580 Fort Collins, CO 80524 Phone 9.70-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (chock all that apply). ❑ Air Conditioning 0 Demolition (interior non-structural) 0 Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log trieating unit 0 Lawn Sprinkler 0 Mobile Home replacement I7 Floating 13 Sewer Line ❑ Photo -voltaic Ventilation Nater Heater CI Water Line 0 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 # � I30 Ia 52 for 01rice use only 50-t0 Sob Site Address treauiredi 371 !� Shallow 1)0 Prooertv Owner Ivamq- I Address i i r Aplicant Name Address Date _ _.._�a� �5 Value of Construction (labor, materials, profit) = C C_D XfTig ZMrM i City/State Zia 9 Zip - Phone • 1. Phone 0 Contractor Address f f city/State- p Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 0 Here Xpeport Safer tax number n requlrw ar a# ow,ftctors. Are you paying with your trust account?)K Yes 0 No Is this a residential or 9mmercial project? jV "+-!i%nbal 0 Commercial If residential, is ' "A Single Family Det m$wd 0 Condo/townhome (single family attached) © Dupiex L1 Multifamily (apartment) O Garage , I If commercial, is it: 10 flank ❑ Bar 0 Church 0 Hotel/Motel 0 Medical office - D Office ❑ Retail ❑ Restaurant ❑Other (ex lain) Is this building 50 years of age or more? ❑ Ye5 n10 Ify. ypumayneed tbcantadHlsronrPreservation If this is for a demolition permit, what year was the tlding constructed? If prior to 1975, you wi// n�47n asbe.50S assessment to submit w/th MX application, - - --! Description of Work.. c.NrrnKieryoackflow preventer, must lest licensed plumber. If first-time A/C, must list licensed etectrician. Subcontractors: List the Company name or City of Ft Collins license f' Electrician Plumber MCClwnical 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. 1 know that a permit is not valid until It has been paid and issued. Applicant: t Print Name: