HomeMy WebLinkAbout6369 Compton Rd - Applications/Water Heater - 05/20/2014A .
Planning, Development &Transportation
Clt)+++/}Of t 1 N. College Ave P.O. Box 580
Folrrr` CollinsI I IFort Collins, CO 80524
Phone 970-416-2740 Fax.224-6134
OVER-THE-COUNTER PERMITS ONLY • $ ioz.3Z
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 0 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 the application. Incomplete applications will not be.accepted..
Application # ����2 1 Date `Dr-20--1t
For office use only
Job Site Address (required)
Comp f0,
Value of Construction (labor, materials, profit)
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Property Owner Name
Address 636 9
City/State Zip JP05,2< Phone ?ono
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Applicant Name
Address-- 3 /0 9
City/State F4 Zip ea'a 5'. Phone 920
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Contractor
Address
City/State Zip Phone
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Contractor City of Ft. Collins Sal41ax # .
Sales tax number is required by all contractom
Are you
paying with your trust account? ❑ Yes to
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: ksingle Family Detacha ❑ 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 SO 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/bacldlow 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:,
Print Name: l ignature Date