HomeMy WebLinkAbout215 Cheops Ct - Applications/Water Heater - 04/12/2013City of Planning, Development & Transportation
281 N. College Ave P.O. Sox 580
/Fort Collins 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 # 13I,3O i (.Sb Ot Date
Far office use only 3 (D Ste_
3ob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
IN
City/State Zip Phone C(7D
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Applicant Name Address
City/State Zip Phone
ontractor ^ Address
City/state Zi Phonea76
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Contractor City of Ft. Collins I Tax #
Are you paying taxes here or by report?Here ❑ Report
Sale; tax number isrequwedbyall con actors.
Are you paying with your trust account? ❑ Yes JD -No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: 0-tingle Family Detached ❑ Condoltownhome (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 prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work )Qt- @ 41 (:A . K:b € k!)( -\7p t /i I_ t�-LP i
*If lawn sprink€er/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 I
Electrician Plumbei L? ,� 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: r�
Print Name��Signatu�('�t�i Ii�'T��i,'i Date
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