HomeMy WebLinkAbout2629 Redwing Rd - Applications/Water Heater - 11/02/2011Fort 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 ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation Jid 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 #
For of%e use only
Date
Job Site Address (required)
Value of Construction (labor, materials, profit)
-?/P a edLu ; _�>, tj d-001oor
`g 9/3, o 6
Property Owner Name
Address
City/State Zip
Phone
_br,zAe_ Park, /7)q mf"
a4.??gvsio fl,6d (S
J'03�24 0a3-73
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
/014' en ,'
S'/a Al
oocl sd' CO
Contractor City of Ft. Collins Salesax #
Are you paying taxes here or by report?
❑ Here eport
Sales tax number is required by all contactors.
Are you paying with your trust account?
❑ Yes 91<0
aS0 4
Is this a residential or commercial project? ❑ Residential E tbmmercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage /�
If commercial, is it: ❑ Bank ❑ Bar El Church ❑ Hotel/Motel ❑ Medical office ffoffice ❑ 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? JV—:%
If prior to 1975, you w111 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 '�i/ ��g 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: W / l'/i /� g
Print Name:_ i //Qyd K� ?^ Si nal: Date al - rL -
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