HomeMy WebLinkAbout407 N Pearl St - Applications/Water Heater - 08/04/2011AUG-16-2011 14:02 From:Allen Service 970 484 4448 To:92246134
Paee:5/5
City of Planning, Development & Transportation
281 N. College Ave P.O. Box 530
Fort Coign Fort Collins, CO 80524
/~ Phone 970-416-2740 Fax 224-6134
OV -THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 13 Air Conditioning
❑ Demolition (interior non -strut ural) O Electrical Alteration (not service change) 1) Gas Lighter O Gas Log
❑ Heating Unit ❑ Lawn Sprinlller O Mobile Home replacement O Roofing O Sewer Line ❑ Photo -voltaic
❑ Ventilation Water Heater Water Line d Wood/Peilet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable inforilation on the application. Incomplete applications will not be accepted.
Application
office use
Date ,9-4(—//
Job Site Address (required) Value of Construction (labor, materials, profit)
leS77 ACC_ C D D /S Oi
Properly Owner Name Address Gty/State Zip Phone
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Applicant Name Address City/State Zip Phone
Contractor , ---- dressC+1tY/StateZip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report
S3/es tax number is rcquirtal by all cfirgo actoa. Are you paying with your trust account? )K Yes ❑ No
Is this a residential or commercial project? Residcndal ❑ Commercial
If residential, is it:>19 Single Fa ily Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamil (apartment) O Garage , •
If commercial, is it: ❑ Bank ❑ Bar 13 Church D Hotel/Motel ❑ Medical office 11 Office ❑ Retail
O Restaura r O Other (explain)
Is this building 50 years of age r more? ❑ Yes O No If yes, you may need to Contact Hlstoric Preservation
If this Is for a demolition permi , what year was the building constructed?
If prior to 191S, you will need an sbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow prevent r, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Listdhecompan name or Cily of Ft Collins license 0
Electrician Plumbet Mechanical
Roofer Other
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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 been paid and issued.
Applicant:
Print Namc:_ Signatur DateL_ 4P
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