HomeMy WebLinkAbout3815 Celtic Ln - Applications/Water Heater - 02/28/2014Planning, Development & Transportation
City.
Ft }}�� 281 N. College Ave P.O. Box 586
6r1 Collins Fort Collins, CO 80524
�- Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY �zeN
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 IA 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 # I 11+61100
For office rse only
Date
Job Site Address (required) I Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip
19
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Phone
P 55 Crso v / 5 / �.
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117Z - l zo S
Applicant Name Address
City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone q ss Y-
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Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ►3eport
Cale tax number isIegrdredbyall mnbactors
zz SS.7
Are you paying with your trust account?
51 Yes ❑ No
Is this a residential or commercial project? I R Residential ❑ Commercial
If residential, Is it: f?3 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?
Ifpr/or to 1975,' you wi/f need an asbestos assessment to submit with this app/ica fon.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensedelectridan.
Subcontractors: List the company name or Gty of Ft Collins license ?
Electrician Plumber
Medianical 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. � Z c-N"- I-J
Date 2
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