HomeMy WebLinkAbout1957 Mainsail Dr - Applications/Water Heater - 06/26/2013Frowl'oudre Valley Air 9704932073 07/08/2013 13:24 #373 P.001/003
.City of I j p planning. Development & Transportation
Fort Collins Fort Co! ns, CO 80524 .O. Sox 580
�.- 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, provide make, model and
manufacturer).
Complete all applicable Information on the application.
Application #_9 4 7U' 3 L121 f
rff e use only
Incomplete applications will not be accepted.
Date
Job Site Address (required)
sn
Value of Construction (labor, materials, profit)
ag 31
Property Owner Name Address
City/State Zip
Phone
�O
Applicant Name Address
City/State Zip
Phone'
Contractor Address
Rp&-x&L'�oILQ
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
CRAM -
Are you paying taxes here or by report? O Here
60 Report
Sales tax number isrequiredbyallaontraanrs.
Are you paying with your trust account? AYes
13 No
Is this a residential or mmercial project? Q�Reslclentlal ❑ Commercial
If residential, Is it: Single Family Detached ❑ Condo/townhome (single family attached) • --❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑liar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O No If yes, you may need to contact Historic Preservation
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 annllcaNbn_A— "`A%R t% --
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed
Subcontractors: List the company name or Gty ofht Collins Ikense 0
l:lectridan 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:
Print Name: ��C ��Q G� Q�,M Signatures �� a ..1,.� Date