HomeMy WebLinkAbout3820 Observatory Dr - Applications/Water Heater - 01/06/2014City Of Planning, Development & Transportation
Fort Collins For N. College Ave P.O. Box 580
Fort Collins, CO80524
Phone 970-416-2740.2740, 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 (int rior non-structural) ❑ Electrical Alteration. (not service change) ❑ Gas Lighter ❑ Gas Log
❑ 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 #_ A ;4o0o2.::'j. Date V��PI. OU. ZQ 4.
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
43NIJao d�nF_ �R 16Xql �dr- o =-
Property Owner Name Address
City/State Zip
Phone ID
L� R VC F D
F ;a `� r'� c�ui
8b 66��
Applicant Name Address
City/State Zip J
Phone
,F 6
WW —% K t>LJlsv cU,
I N 1
Contractor Lic # Address
City/State J zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
N6 Here ❑ Report
sales tax number is required by all contractom
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or c9trimercial project? Qf Residential ❑ Commercial
If residential, is it: fM Single Family Detached ❑Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Ho)el/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (expiap)
Is this building 50 years of age or more? ❑ Yes 19 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If plior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
F—
*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 #
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: I ,�1� � /
Print Name: �f"1I aq ROC�� Signature I
�) �" �?2 Date
>.5