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HomeMy WebLinkAbout719 Columbia Rd - Applications/Water Heater - 08/28/201308/29/2013 07:56 FA% [a001 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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit 01awn Sprinkler © Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation (yater 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 # M -� { I Date For office use only Sob Site Address (mqu#rd) Value of Construction (labor, materials, profit) PrV /rty Owner Nam�e�} / Address Cityy/-//State 1C) Phone[%p x/�Bp q f Applicant Name Ran 1 tLpr1r1e:11,Ge11 `7�IQ Address City/State Zip �a -�f rr y Aa lye Fr. C'rllly��;C . Sr z� Phone �t -4�13 _3�3Cr Contractor LI4' Al P- 174'19? Address Qty/State Zip Phone � r'f11Ern CD(Dr Oil 7qq. ee3. L.+err4( -9a)3r-1q2 i=t, &1163 0IN FZ52 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report saleTtax numbwIstmomdbya#rontradom Are you paying with your trust account? ❑ Yes )KNo Is this a residential or com al project? Q"P cif residential, Is It: 1211,4ngle Family Detached ❑ Multifamily (apartment) If commercial, is it: ❑ Bank ❑ Bar ❑ Church sldential ❑ Commercial ❑ Condo/townhome (single family attached) 13 Duplex ❑ Garage ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more?' O Yes ❑ No If yes, you may need to contact Hlsfniic Preservat/on If this is for a demolition permit, what year was the building constructed? Ifprror to 1975, you will need an asbestos assay ent to submit WM dils app lcafkn. Description of work *If lawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subombectora: List the company name or Cyty of Pr (Milos HCense 0 Elediidan 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 vaild until It has bean paid and issued. Applicant: {{� Print Neme: riLOA I' i) rIC l 1:5E'! 1 nature Date do