HomeMy WebLinkAbout351 Linden St - Applications/Water Heater - 10/19/201310-19-13;03;30PM; ;970-484-4448 # 6/ 14
Fort Collins
Planning, Development &'transportation
281 N. College Ave P.O. Box 580
Fort Colllns, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the follovuing 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. Incomplete applications will not be accepted.
Application # 91 305V IT` Date D —
foroffice use only
Job Site Address (required)
35/ �inD�RJ .S�`=G
G o
Value of Construction (labor, materials, profit)
d%�ay �3SG �od
perty owner, 361
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�C//cif EV Sr L_zd. state "Phone
y
I'a nt� er
'Applicant Nam
r'�1
Address
1 LJti
City/State Zip
dos
Phone
qra- gi
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ktlre"nctor
101
Address
E- i
City/State Zip
, P d-f 60 $05a
Phone
vil- fig
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here Pkeport
Sales tax numberQ i �byallrontractors
Are you paying with your trust account?
.Yes ❑ No
Is this a residential or commercial project? ❑ Residential Commercial
If residential,. is It: ❑ single Family Detached ❑ Condo/ ownhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ElChurch ❑ Hotel/Motel ❑ Medical office AOffice ❑Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? 0 Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pr1or to 1975, you will need an asbestos assessment to submit with this application.
Description of
k
-2-1-13
*If lawn sprinkler/backflow preventer, myA list licensed plumber. If first-time A/C, must list licensed electrician.
Subco ntractors: List the company name or Orly of Fe Collins //tense #
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: I I ! l,n Signature Date l 8