HomeMy WebLinkAbout708 Garfield St - Applications/Water Heater - 12/30/2011JAN-09-2012 16:49 From:Rllen Service
City of
Fort Collins
970 484 4448 To:92246134 Pa9e:6/11
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
O Demolition (interior non-structural) O Electrical Alteration (not service change) O Gas lighter ❑ Gas Log
• Heating Unit O Lawn Sprinkler O Mobile Home replacement ❑ Roofing 0 Sewer Line O Photo -voltaic
• Ventilation Water Heater 0 Water Line ❑ Wood/Peilet Stove (must be EPA certified, provide make, model and
manufacturer .
Complete all applicabbl�leInformation on the application. Incomplete applications will not be accepted.
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Application # 4/) m o _ Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
FloS PzRRne D 94. l-c- C-o S05Aq 5-0t
Property Owner Name Address City/State Zip Phone
%J;f)._FRiS iE Sair1c, 90a
Applicant Name I Address City/State Zip Phone
Contractor Address City/State Zip Phone
Al
loin_ v-y /f7/ _i, n CD 405� �8�/- qjS 1
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? O Here (Report
Sales fax numbe-is repuircd by all cunt -actors. Are you paying with your trust account? X Yes O No
IC)n/C)
Is this a residential or commercial project? $Residential 13 Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) 0 Duplex
❑ Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 0 Office 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes O 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 applicabbn.
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*If lawn sprinkler/backnow 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 0
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, Signatur Date A_��—1 i