HomeMy WebLinkAbout2325 S College Ave - Applications/Water Heater - 03/24/2014b"v6 vr# MPAA ' " Planning, Development & Transportation
City Of 281 N. College Ave P.O. Box 580
Fort 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 X 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 # 514 b I417 Date 3041)q
For office use only
Job Site Address (required)
a N C
Value of Construction (labor, materials, profit)
P wl 00
Property Owner Name Address
City/State Zip Phone
Applicant Name Address
City/State Zip Phone
Contractor Address
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City/State Zip Phone
-VD- ,390
Contractor City of Ft. Collin Sales Tax #
Sales tax namber s rerluinaJbyall contractors.
Are you paying taxes here or by report? ❑ Here ❑ Report
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential Xcommercial
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 ❑ Medi4al office ❑ Office J� Retail
❑ Restaurant Other (explain)
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Is this building 50 years of age or more? ❑ Yes 2Mo fyes, you gay need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
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*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or��C""ity of Ft Collins license #
Electrician Plumber nll"Ul 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: �
Print Name: '���^r t TT�% Signature Date 3 /