HomeMy WebLinkAbout3709 Shallow Pond Dr - Applications/Water Heater - 12/27/2013Dec•27. 2013 8:52AM 9704844448 ALLEN PLUMBING&HTG No,4808 P. 6/9
��� Planning, Development& Transportation
FI-� Y} 281 N. College Ave P.O. Box 580
ort Collins 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) El Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 11 Sewer Line El Photo -voltaic
11 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 applicationswillnot be accepted.
Application # 5I 3OW05-1 Date
far office use only
Job Site Addr (req ked)
32 hallow lld L
Value of Construction (labor, materials, profit)
re, 905' g // .oa
Property OwnerMe, Address
Clty/State Zip
Phone
Applicant Nam Address
i f{l �! 1 / L 1 M
City/State Zip
g0
Phone
q7,p. I8 V. gill
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ntractorAddress
n e►v l01 &
p1y/State FO&p
i.N. lJ (,/iU�
` Phone/'o`'�
7 `l 7
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here Pkeport
Sa/es tarnumberMbya//mn(racfvrs
Are you paying with your trust account?
Yes 11 No
Is this a residential or merdal project? A Residential ❑ Commercial
If residential, is it: Single Family Detac ed ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 11 Medical office ❑ Office ❑ Retall
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes LINO Ifyes, you may need to conbctHistaricPreselvmYon
if this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will Wed an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electician.
Subcontractors: List the company name or Clty 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: t '1
Print Name: 1-1 Cr -
Date