HomeMy WebLinkAbout636 Cheyenne Dr - Applications/Water Heater - 07/01/2013Jul 09 13 04:58p . Rues, LLC 970-619-8074 PA
Fcity Of
6r! Collins
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 Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer line ❑ Photo -voltaic
❑ Ventilation % Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, providemake, model and
manufacturer).
Complete all applicable information
owhe
n the application. Incomplete applications will not be accepted.
Application # i _7d �fol� 3' J —� Date I l3
For aline use only
Job Site Address (required)
Value of Construction (labor, materialsr profit)
Property Owner Na a Address
City/State Zip Phone 9 %9-
5{AscLr, e�� �.. ��C Cis Cu ;RU-5�S 568-141
Applicant Name Address
City/State Zip Phone R10-
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Contractor Address
City/State Zip Phone (n%
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here '® Report
Sales tar number isrequlredbyall confractom
Are you paying with your trust account? EA Yes ❑ No
Is this a residential or commercial project? CrResidential ❑ Commercial
If residential; is it: ❑ Single Family Detached fBCondo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it; . ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to conftrdHistoric Preserrafron
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this applicahc;n,
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List dire company name or City of R Collins 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 bonding construction, I know that a
permit Is not valid until it has been paid and issued.
Applicant
Printll ame.B 'r' ✓ � l� 1� Signature _ Date 7 I 3