HomeMy WebLinkAbout2313 Cedarwood Dr - Applications/Water Heater - 04/16/2013Fort 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.
Application # I( 3 d 1 1 1 l!!
For office use only
Incomplete applications will not be accepted.
Date �1 �16 — /3
Job Site 2Address (required) J Value of Construction (labor, materials, profit)
Property Owner Name
Address
4.2
City/State Zip Phone
Applicant Name
Address
City/State Zip Phone
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G�-�-�% 91s 9 �O� �96
Contractor Lic #
G JPs"TTw G b ��
Address City/State Zip Phone
AX'4 7W/ 4z4__1�4d �' Ao.S�r9 O'8'5p;;�
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? A-lere ❑ Report
Sales tax number is required by all contractors:
Are you paying with your trust account? ❑ Yes _,"o
Is this a residential or commercial project? ❑
If residential, is it: ")E:�,Single Family Detached
Residential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor 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: Llst the company name or City of Ft Collins license #
Electrician Plumber 673 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 Name: Signature