HomeMy WebLinkAbout1900 Bronson St - Applications/Water Heater - 01/21/2014Frowl"oudre Valley Air 9704932073
01/21/2014 16:42 #786 P.001/001
Fort Collins
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 ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation "ater Heater ❑ Water Line ❑ WoodiPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # Flgoo 363
For office use only
Date A
Iob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
—
Applicant Name Address , City/State Zip Phone
Contractor _ Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here bZ Report
Sales tarn mberIstequiedbyaffwntiacnxs, Are you paying with your trust account? XYes CZ No
Is this a residential 4r �commercial project? t tesidential ❑ Commercial
If residential; is dt: `0 Single Family Detached ❑ Condo/tawnhome (single family attached) • - ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Rail
❑ Restaurant ❑ Other (explain)
is this building 50 years of age or more? ❑ Yes ❑ No IfY1124 you may need to contact HistoricPreservadon
If this Is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/back-flow preventer, must list licensed plumber. If first-tlme.A/C, must list licensed electrician.
Subcontractors: List the company name or City of ft Collins /kense 4F
Electiidan Plumber MechardmL. 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 constructdori. I know that a
permit Is not valid until It has been paid and issued.
Appiicsnt: \
Print Name: Signature A'%&" Date