HomeMy WebLinkAbout2204 Purdue Rd - Applications/Water Heater - 01/06/2014City Of Planning, Deveiopment & Transportation
281 N. College Ave P.O. Box 580
F rt 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) ❑ Electrical Alteration. (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation dater 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 # bD f4 Date It
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
I�i�r�tA t $
Property Owner Name
Address
City/State
Zip
Phone
€vi,1 ►R4)nso
14o4 P rd
a ;.i (A .
$6525
9�� 4/(a— 5931
Applicant ame
Address
City/State
Zip
Phone
Contractor Lic # 6S(P
Address
City/State
Zip
Phone
vw- Pus ," (R,4 I,.:' }'lu.Hb�� i
536 S��rc
C4 Cy/f�xs
co $�SJ�
q7u 5is ���Z
Contractor City of Ft. Collins Sales ax #
Are you paying taxes here or by report?
❑ Here XReport
Sales tax number is required by all. contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? Residential 0 commercial
If residential, is it: ;Single Family Detached ❑ Condo/townhome (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 If yes, you may need to contact Historic Preservation
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' R-Cele.ce ck 40 gal
*If lawn sprinkler/back low 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 PA P- 615 i' 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: U Sit >h
Print Name: Signature
Date l L 111