HomeMy WebLinkAbout5027 Northern Lights Dr - Applications/Water Heater - 01/24/2014Jan 21 14 09:39a Rues, LLC 970-619-8074 p.3
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
❑ Healing Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Cl Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 Water Heater ❑ Water Line ❑ WoocUPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #�4���— Date hl� 2�l • 20i�
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Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zia Phone
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Applicant Name
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Address
City/State Zip Phone
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Contractor
Address
City/State Zip Phone U%"�5
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here IR Report
sales tax number isregmnedbrall conbadors
Are you paying with your trust account? 12 Yes ❑ No
Is this a residential or commercial project? ki Residential ❑ Commercial
If residential, is it: ' Single Family Detached ❑ Condoltownhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it:. ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail,
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you wfll need an asbestos assessment to submit with this application.
Description of work
!r iawn spriruaer/oacKnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Gist mire company name or City 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: .1
Print NameQ v t- Signature ID.I f r i