HomeMy WebLinkAbout624 Sydney Dr - Applications/Water Heater - 09/20/2011SEP-23-2011 15:51 From:Allen Service 970 484 4448 To:92246134
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City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Cothns Fort Collins, CO 80524
�L Phone 970-416-2740 Fax 224-6134
OVER -THE -COULTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior nun-struc ural) O Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unilr _O Lawn Sprin ter O Mobile Home replacement O Roofing ❑ Sewer Line ❑ Photo -voltaic
O Ventilationl,`�kwater Heater Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer.l.
Complete all applicable infor4ation on the application. Incomplete applications will not be accepted.
1 Application # 11 ofi
i 3 Date
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Job Site Address equiredj
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Value of Construction (labor, materials, profit)
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Address
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City/State Zip Phone
Applicant Name
Address
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City/State Zip Phone
Contractor
Address
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Tax 9
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Clty/State Zip Phone
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Are you paying taxes here or by report? ❑ Here Report
Are you paying with your trust account? g Yes ❑ No
Contractor City of Ft. Collins Sales
Shces tax number a required by all cont
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Is this a residential or commercial project? AResidential ❑ Commercial
If residential, is it: Single Fa ily Detached O Condo/townhome (single family attached) ❑ Duplex
Multifami (apartment) ❑ Garage
If commercial, is it: 0 Bank O Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ Office O Retail
❑ Restaura t ❑ Other (explain)
Is this building 5O years of age or more? O Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolltlon permit, what year was the building constructed?
If prior to 1975, you will need an sbestos assessment to submit with this applicao'on,'
Description of work A&M �n
*If lawn sprinkler/hackflow prevent r, must list licensed plumber. If First-time A/C, must list licensed electrician.
Subcontractors: list the company name or City of Ft Collins license A?
Electrician Piumbi Mechanical Roofer Other
I hereby acknowledge that I have rc ad 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: �
Print Name: ��rrl IJ�I Signatur - Date