HomeMy WebLinkAbout5620 Fossil Creek Pkwy - Applications/Water Heater - 10/31/201311-01-13;09:07AM; ;970-484-4448 # 10/ 11
Fort Collins
Planning,, Development & Transportation
281 N. College Ave P.O. Box 560
Fort Collins, CO 80524
Phone 970-416-2740 Fax 27-4-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
C3 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 # F? 13CG 05q _
For office use only
Date /0 31--13
Job Site Address (requl
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value of Construction (labor, materials, profit)
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Contractor City of Ft. Collins Sales Tax
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Are you paying taxes here or by report? Here Pkeport
Sales tar number lorwal d by all contractors.
Are you paying with your trust account? Yes ❑ No
Is this a residential or commercial project? ential ❑ Commercial
If residential, is it: 11 Single Family Detach d sl Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar 13 Church E7 Hotel/Motel ❑ Medical office ❑ Office 0 Retail
11 Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you will need an asbestos assessment to submit with this application.
Description0of work CKPNOLie � n�
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*If lawn sprinkler/backFlow 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 rX
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 ordfnanoes and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: rCy-irhi-N Signature pate f D I 1`>( 3