HomeMy WebLinkAbout351 Linden St - Applications/Water Heater - 11/29/201312-03-13;08:02AM; ;970-484-4448 1# 8/ 10
Fort Collins
of
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 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 El Sewer Line ❑ Photo -voltaic
El 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 # 130
For offlice use only
Date //-�2 9 /-9
Job Site Address (required
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/state Zip Phone
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Applicant Nam
Address
city/state Zip Phone
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Contractor City of Ft, Collins Sales Tax #
Sales tax numbMbyall contractors
Are you paying taxes here or by report? ❑ Here eport
Are you paying with your trust account? )`.Yes ❑ No
Is this a residential or commercial project? 13 Residential mmerclal
If residential, is it: ❑ Single Family Detached ❑ Condo/ wnhome (single family attached) ❑ Duplex
uldfamlly (apartment) ❑ Garage
If commercial, is IA ❑ Bank II Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 13 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 nXd an asbestos assessment to submit with this app§/ ea ion.
Description of work
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If flrAt-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins licensv #
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:CXI-M11 Signature
LL Date /N / -1
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