HomeMy WebLinkAbout1508 Buckeye St - Applications/Water Heater - 08/04/2011RUG-16-2011 14:02 From:Allen Service 970 484 4448 To:92246134 Paee:4/5
City of Planning, Development & Transportation
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281 N. College Ave P.O. Box 580
/,._ ort Collin Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVEN -THE-00UNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). O Air Conditioning
❑ Demolition (interior non -strut ural) ❑ Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
❑ Heating Unit O Lawn Sprin ler O Mobile Home replacement ❑ Roofing d Sewer Line O Photo -voltaic
O Ventilation Water Heater Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manutacturer).
Complete all applicable information on the application.
Application # '
For office use on
Incomplete applications will not be accepted.
Date _ ?- LI-//
Job Site Address (required)
Value of Construction (labor, materials, profit)
50g
137a.04
Property Own Name
Address
City/state
State Zip Phone
Jodi e'e
s�
631-N4500
Applicant Name
Address
City/State Zip Phone
Contractor
Address
Clty/State Zrp Phone
Tax #
Are you paying taxes here or by report? ❑ Here XReport
Contractor City of Ft. Collins Sa4s
Saks tax numberis required by all con
cmrs.
Are you paying with your trust account? )Q Yes CI No
Is this a residential or commercial project? ; Residential ❑ Commercial
If residential, is it: �( Single Fa ily Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifarnil (apartment) ❑ Garage
If commercial, is it: ❑ Bank 0I8ar O Church ❑ HOtel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age br more? 0 Yes n No Ifyes, you mayneed to contact Histon;7Preseivation
If this is for a demolition permit what year was the building constructed?
If prior to 1975, you will need an sbestos assessment to submit with this application.
Description of
*If lawn sprinkler/backnow prevent�r, must list licensed plumber. If first-time NC, must list licensed electrician.
Subcontractors: List the company name or City ofR Collins license #
EleQlruan Plumbl Mechanical Roofer Other
i hereby acknowledge that I have r�ad this application and state that the above information Is Complete and correct. I agree to
comply with all requirements contai 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: f rl lJl t�
Print Namc:� _ Siynatur Date �ry�_