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HomeMy WebLinkAbout2612 Fox Run Run Ct - Applications/Water Heater - 09/24/2013Sep•24. 2013 3:16PM 9704844448 ALLEN PLUMBING&HTG No•4599 P. 1/1 C;tyof Planning, Development & Transportation 281 N. College Ave P.O, Box 580 IFQrt Collins Fort Collins, CO 80524 Phone 970-416-2740 Fax 22+6134 OVER-THE-COUNTER PERMITS ONLY This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditio ing Cl 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 M Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all pplllcable Information on the application. Incomplete applications will not be accepted. Application #�/��V_ �✓r-� Date ' ��3 For o/l9ce use only "13 Job Site Address (requi?e y i,�/u,�, Value of Construction (labor, materials, profit) Property Owner N Address City/State Zip Phone Applicant NameA oil Address tvg / . 0" City/State Zip Phone 905Aq q70. 8 g/l tractor Address jkn ertri & 101 C. k lk K City/State AN. r e, .A a Zip Phone F0501 y y6ey- M Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? C1 Here Pkeport sales tax number * Tired by all contractors Are you paying with your trust account? Yes ❑ No Is this a residential or c mmerdal project? Residential ❑ 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? ❑ Yes ❑ No Ifyes, you mayneed to contact!-l/storic 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 applfbation. Description of work% �X I L 64" ky'y r i < u.A C11 11 *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Llst the company name or City of Ft 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 building construction. I know that a permit is not valid until it has been paid and issued. Applicant: Print Name: r SY•n Signature pate