HomeMy WebLinkAbout3424 Carlton Ave - Applications/Water Heater - 06/04/2013SUN-07-2013 06:48 From:Rllen Service 970 484 4448 To:92246134 Paee:12/12
-Fart of
Planning, Development: & Transportation
281 N. College'Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-274o Fax 224-6139
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
Cl Demolition (interior non-structural) 0 Electrical Alteration (not service change) O Gas Lighter ❑ Gas Lag
:Ideating Unit O Lawn Sprinkler O Mobile Home replacement O Roofing d Sewer Line ❑ Photo -voltaic
0 Ventilation +Vater Heater ❑ Water Line ❑ Woodtpellet Stove (must be EPA certified, provide make, model and
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Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #—&( 277q Date —
For �G.-
For ofce use only
Job Site Address frenuiredf /}
le
Prgoertv Owner NAmq^ Address
A,Ap�plicant Name Address
Value of Construction (labor, materials, profit)
OILY/State Zia
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Phone
a3-97.9�-
Zp Phone
Contractor Address Qty/State Zip Phone
Contractor City or Ft. Collins Sales Tax # Are you paying taxes here or by report? C Here P,eport
Shcr. f tax number is reoulred 6y a!! canAadors Are you paying with your trust Account? Yes ❑ No
Is this a residential or ypmmercial project: 't►� ntlal ❑ Commercial
If residential, is' q Single Family Detached nclo/townhome (single family attached) 1) Duplex
�, 0 Multifamily (apartment) Cl Garage ,
If commercial, is it: C1 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 0 Office. ❑ Retail
O Restaurant ❑ other ( lain)
Is this building So years of age or morel ❑ Yes 'Vo Jf yes, you may need to Contact Hlstprie Preservation
If this is for a demolition permit, what year was tKe"�ilding constructed?
Jf prior to J975, you wil/ ne'Pe pan asbestos assessment to submr't with ttA apptcatl+on,
Description of vgrk,.
i ion., sNi inKier/oacktlow preventer, must fist licensed plumber.
If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license 0
Eiectritian , Plumber Mechanical Roofer Other
I hereby acknowledge that 1 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: (,I t1
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Print Name: ���rl[]ako Si natur - -
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