HomeMy WebLinkAbout2009 Stover St - Applications/Water Heater - 06/08/2013Jun 12 13 03:57p Rues, LLC
970-619-8074
PA
City of
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 5w
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 O Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 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 # 13V a a W Date
For ofrx-e use only
Job Site Address (required)
Val Ne of Construction (labor, materials, profd)
Pro erty Owner Name Address
City/Stater Zip
Phone
Applicant Name Address
�C-ter I Ct�rY}�.r ` 65
/ City/State Zip Phone 410 `
Love i Co 6o5:yj Lr?)5 -.4 C�-) i
Contractor _ Address
City/State Zip
Phone U%--45
i-� (' r) cu r,'� n 1-4'c1��iC "i r� �� I,Lt iv�b ; n e�
425
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here 12 Report
Sales tarnumber /sregvIredbyaffcontactors.
=r `i 7)" !
Are you paying with your trust account?
[A Yes ❑ No
Is this a residential or commercial project? i(Residential ❑ Commercial
If residential, is it: mgle 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 50 years of age or more? ❑ Yes ❑ No If yes, you may need 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 tiiis app%rcabbn.
Description of work
it kawn,wrintiuer/oamow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors. L6tUAemmpanynameorCiryofFtCollins license #
Eledridan 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:
Print Name �` r �1�ia) 111 >? i� Signature
If