HomeMy WebLinkAbout400 Briarwood Rd - Applications/Water Heater - 09/21/2011SEP-23-2011 15:52 From:Allen Service 970 484 4446 To:92246134
Page:719
City Of planning, Development & Transportation
! 281 N. College Ave P.O. Box S80
Fart CoLti Fort Collins, CO 80524
� Phone 970-416-2740 Fax 224-6134
I
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non -strut ural) O Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
O Heating Unit O Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line. 0 Photo -voltaic
O Ventilation Water Heater Water Line 0 Wood/Pallet Stove (must be EPA certified, provide make, model and
manufacturer)
Complete all applicable inforr{ ation on the application. Incomplete applications will not be accepted.
Application # �� �`1 Date
Far office use on
Job Site Ad ss (required)
'
Value of Construction (labor, materials, profit)
P erty Owner Na7 I
Address
City/State Zip
i
Phone
2R
%ren
Applicant N me i
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
q?Ll- q1F411
Contractor City of Ft. Collins Salas Tax #
Are you paying taxes here or by report? O Here
Report
Sales tax number a required by an cony actors
Are you paying with your trust account? )K Yes
O No
Is this a residential or commercia
If residential, is it: Single Fi
/❑ Multifami
If commercial, is it: ❑ Bank C
0 Restaura
Is this building 50 years of age
If this is for a demolition perm!
Oprior to 1975, you will need an
Description of work
*If lawn sprinkler/harki'low
Subcontractors: List the i
Electrician
project? AResidendal ❑ commercial
nily Detached 0 Condo/townhome (single family attached) O Duplex
f (apartment) ❑ Garage
Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office 0 Retail
❑ Other (explain)
r more? 0 Yes ❑ No 7f yes, you may need to contact Historic Preservation
, what year was the building constructed?
rsbP.stos assessment to submit with this application.
r, must list licensed plumber. if first-time A/C, must list licensed electrician.
name or City of ft Collins license +t
Mechanical Roofer
Other
I hereby acknowledge that i have read this application and state that the above Informatlon Is complete and correct. I agree to
comply with all requirements contair)ed herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has b en paid and issued.
Applicant:
Print Name. Signatur Date