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HomeMy WebLinkAbout2030 Derby Ct - Applications/Water Heater - 07/03/201307/15/2013 13:27 FAX 9703517127 RAMS PLUMBING INC IN01/001 FCiof art Collins /11� 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 appiication Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning ❑ Demolition (interior non-structural) ❑ Electridal Alteration (not service change) © Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation Rater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all app ' aple information on.the application. Incomplete applications will not be accepted. Application # l /3 Teo Date 7131 I� For ofte use only Sob Site Address (required) Value of Construction (labor, materials, profit) Property Owner Name'? Address City/State ZIP Phone 7t)6 tR)2'. 6L4_ 1�;570e_0T1 b r) CC) TO 61:66 - 6 0C, J Applicant Name Address City/State Zip Phone Contractor Lic # Address City/State Zip Phone Rn"t) 12LI-M1jir.1E) —M �5052.z Contractor City of Ft. Collins Sales Tax # Are you paying.taxes here or by report? ❑ Here CoReport Sales tax numbwIsrequlred by all contractors. Are you paying with your trust account? 2lYes 0 No f H2- 33c Is this a residential or commercial project? COResldentlal Q 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(explain) Is this building 50 years of age or more? 17 Yes Ci No If yes, you may need to contact H/stor/c Preservation If this is for a demolition permit, what year was the building constructed? Ifpnor to 1975, you will need an asbestos assessment to subm/t w/th this appllcat/on. Description of work 1 STD l.<, 90 60 L.. N 16 Wd7e.2. W VQ7Vg *If lawn sprinkler/backfiow preventer, must list licensed plumber. If First-time A/C, must list licensed electrician. Subcontractors. List the company name or City of Ft Collins license # Electrician _ Plumber Mechanical Roofer J 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: Print Nam�/3 e: Q� 0'J M0Qj2 � Signature Q.e� dv i) � ftaA4 , Date