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HomeMy WebLinkAbout2750 Sage Creek Rd - Applications/Water Heater - 08/12/2011Fort of Planning, Development & Transportation 281 N. College Ave P.O, Box 580 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 Alterstion (not service change) ❑ Gas Lighter Cl Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation VWater 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 # l i (%�� _ Date 12 1 For olffce use only Sob Site Address (requ/A 9 Value of Construction (labor, materials, profit) � 6 ZZ • 00 P pe� Own a Address Clty/State Zip Phone rlQNraenrl, 215o &qGo . 17, o I(ns IR 052� qio-2lo-r • q22 A pllcant Nalne J kCS Address City/State Zip Phone o C5a 06bdo" fib- GqA-5a-13 ontrt-a ►t00 Address City/State Zip Phone boSoE 101543 Rd. 35206 %64ogo,-5a73 t &5p Am Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ere ❑ Report $ales nu mguIredbya//con"ctors Are you paying with your trust account? Imes ❑ No Is this a residential or commercial project? KReSidential ❑ Commercial If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family, attached) © Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, Is It; ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other" lain) Is this building 50 years of age or more? O Yes o If yes, you may need to contact Historic Preservation If this Is for a demolition permit, what year was th building constructed? IfprYa to 1975, you will need an asbestos assessment to submit with thisappl/caeon. Description of work *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or LI(y of Pt Collin license # Electrician Plumber Mechanical Roofer Other I hereby acknowledge that I have read this application and state that the above information Is complete and correct, I agree to comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a permit is not valid until It has been paid and Issued. , Applicant:.— r-yt Print Name: Slit III Z 'd 6006 *ON ]VOINOD3A V1130 AdSti:l I loz 'zl '$nd