HomeMy WebLinkAbout2718 W Stuart St - Applications/Water Heater - 06/04/2013Prooertv Owner
nt Name
JUN-07-2013 06:44 From:Allen Service
City Of
rort Goilins
970 484 4448 To:92246134 Pa9e:2112
Planning, Development & 7ranspo,tation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80924
Phone 970-416-2740 Fax 224.6134
OVER-THE-COUNTER PERMIT'S ONLY
This application is to be used to apply for the following permits only (check all that apply). G Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter O Gas Log
�Xj-ieating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line O Photo-voitaic
Q Ventilation 'Vale. -Heater ❑ Water Line O Woodlpellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # JV ^ Cate to
for Office use Only
Sob Site Address frerruiredf Value of Construction (tabor, materials, profit)
Address
air�'-L
City/State Zia - Phona
312 - 00 q
CIty/State Zip Phone
"W . 1105124. q 94f
Contractor Address r� Clty/state' Zip Phone
l?
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? O Here XP,eport I
5�Jes tax number rs required by ari conrraCtors. Are you paying with your trust account? Yes O No
Is this a residential or c mmercial project? 'Ref-:4ential ❑ Commercial
If residential, 1. Single Family Detat:hed ❑ Condo/townhorne (single family attached) ❑ Duplex
U Multifamily (apartment) ❑ Garage I ,
If commercial, is it; O Bank O Bar ❑ Church ❑ Hotel/Motel ❑ Medical office - ❑ office Cl Retail
❑ Restaurant Gl Other I( 131p)
Is this building 50 years of age or more? ❑ Yes ,� Vo lfyrs, ypvmayneed tocontact H/$W/icPreservatiun
If this is for a demolition permit, what year was the b ilding..constructed?
If prior to 1975, ynrr will neorlan asbestos assessment to submit with 104 application.
—�I i
I hereby acknowledge that t 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: G� Jl��! 1 irk
Print Name: SignatuArii Idate