HomeMy WebLinkAbout512 Yuma Ct - Applications/Water Heater - 01/24/201401-24-14;03:34PM; ;970-484-4448 # 6/ 13
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) t7 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Rooting ❑ Sewer Line 13 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 #. �14()n,7,39i7 Date
Forolhce use only
Sob Site Address (requl )
Value of Construction (labor, materials, profit) 00
Property fawner Name Address CI /state
93o A�atir iNt�� (00c �.'
Phone
rent'it 'r_
A j a - & 1 ? 0
Applicant Nam Address
❑ty Sta a
Zip Phone
•� 1 . L1 N
�0 q7O. g X/
ntract0 Address
city/State
Zip Phone
e i ID I S. 4 ]�J K
LN. r% a
SOS y0ay-tag
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? S Here Report
Salestaxnumber' r quie�byallcw,�ctors
Are you paying with your trust account?.Yes El No
Is this a residential or commercial project? esi ntial ❑Commercial
If residential, Is It:: ❑Single Family Detac ed Rondoltownhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office G Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? E3 Yes ❑ No Ifyes, you mayneed to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, you W11 need an asbestos assessment to submit with this applicadon.
*If lawn sprinkler/backflow preventer, must Ilst licensed plumber. If Flrst-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or Gty of Ft Collins Awnse ,#
Eectridan 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 pald and Issued.
Applicant:
Signature
Print Name: I E1
Date