HomeMy WebLinkAbout1632 Foxhall Ct - Applications/Water Heater - 05/07/2014�t of
Planning, Development A 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).
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Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 8Wa 27S2
For office use only
Date S -1- :4
Sob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
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Contractor Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here ❑ Report
mm Sales tax number is required by anaactors.
Are you paying with your trust account? ❑ Yes ❑ No
4-7195
Is this a residential or commercial project? NQRess nual ❑ Commercial
If residential, is it: ❑ Single Family Detached Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) U 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 R�p�a� ri_ a o gg A&4ar. o X I.,,Jrr hf
*If lawn sprinlder/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Ure company name or Lity of Ft Collins license #
Electrician Plumber MP- 656 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: T q
Print Name: ler`t Aur Signature 1 Date-� -I