HomeMy WebLinkAbout214 E Elizabeth St - Applications/Water Heater - 03/08/2011Fort Collins
of
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 ❑ 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 he application. Incomplete applications will not /be accepted.
Application # a&0-0 �✓ Date 'l
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
zta e�"Lam ` $ 600
Property Owner Name Address
City/State Zip
Phone
�
F7
S
Applicant Name Address
City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax. #
Are you paying taxes here or by report?
❑ Here ❑ Report
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 ❑ 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?
If prior 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 regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: CA Print Name: rer) SignatDate
ty� Community Planning and Environmental Services
h ;x ' z`. Building and Zoning Department
s i
E PERMIT AND INSPECTION REQUEST FOR
EXISTING NON-STRUCTURAL CONSTRUCTION
Please print or type0 Q O
Address: ;eo,6 .. -- � - 4
Date:
I/WE as owner(s) of
record of the above property, hereby request a permit for and final inspection of the
installation or construction work described in the following building permit
application, which work was completed or covered without obtaining a permit and
without required inspections during construction. I/we understand and agree that
the City of Fort Collins Building & Zoning Department will perform a final inspection to
assess compliance of such work, some or all of which may be concealed by
permanent construction and finish materials, based on observable conditions and
nondestructive methods: and, that it may not be practical or possible for the City of
Fort Collins to verify full compliance with City building codes without removal of such
permanent construction and finish materials. I/we further understand that any
violations of City Codes related to health and safety associated with the above work
or installation may require correction.
Work performed by:
Name
Date work performed:
(Signature)
(Signature)
For office use only:
Permit/Application Number
Date applied:
Address
Date f
Date
281 North College Avenue - P.O. Box 580 - Fort Collins, CO 80522-0580 - (970) 221-6760 - FAX (970) 224-6134