HomeMy WebLinkAbout2040 Bennington Cir - Applications/Water Heater - 04/30/2013Cit Of Planning, Development & Transportation
Fort Collins 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524 so
Phone 970-416-2740 Fax 224-6134 qJy
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 # b13 dl 1:5 3
For o>hce use only
Incomplete applications will not be accepted.
Date /0 Y"
Job Site Address (required) Value of Construction (labor, materials, profit)0147
Property Owner Name Address
City/State Zip
Phone
Applicarif Name Address
City/State Zip
Phone
Contractor Lia Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
.L "Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ;;No
Is.this a residential or commercial project? .III 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 ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes Je No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was thetbuildingconstructed?
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: List the company name or City of Ft Collins license #
Electrician Plumber 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: rJ
Print Name-AeKyr Signature Date O