HomeMy WebLinkAbout6515 Finch Ct - Applications/Water Heater - 03/14/2014City of Planning, Development & Transportation
I 281 N. College Ave P.O. Box 580
FOI�.} t 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 ❑ 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 # P ('1 0 130 S Date - ( `� - 14
For offlce use only
Job SiteAddress (required)
Value of Construction (labor,
materials, profit)
6
4
Pr ertIy Owner Name Address
City/State Zip
Phone
Applicant me Address
City/State Zip
Phone
p
[� (/`J
Contractor Address
City/State , Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
p0lere ❑ Report
saiestax number isrWuiredbyaiicontractors. A4917-3
Are you paying with your trust account?
❑ Yes Wlo
Is this a residential or commercial project? ❑
If residential, is it: ,Single Family Detached
Residential ❑ Commercial
❑ 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
*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�egulating building construction. I know that a
permit is not valid until it has been paid and issued. / 1
Applicant:
Print Name: V Li'Vt/w---- Signature