HomeMy WebLinkAbout4050 Kingsley Ct - Applications/Water Heater - 12/30/2011JAN-09-2012 16:49 From:Allen Service 970 484 4446 To:92246134
Pa9e:9111
Planning, Development & Transportation
Cityof1 281 N. College Ave P.O. Box 580
Fort G1 It i n S Fort Collins, Co 80524
Phone 970416-2740 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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement ❑ Roofing 0 Sewer Line . ❑ Photo -voltaic
❑ Ventilation Water Heater Cl Water Une ❑ Wood/Peilet Stove (must be EPA certified, provide make, model and
manufacturer . WO j D 7 86*
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # j110 Date /off'30-
for office use only
Job Site Address (required)
o ; n . 1G G
Value of Construction (labor, materials, profit)
C D FWAS_ /1-70.00
Pr erty Owner Name Address
City/State Zip
Phone
kq- a5ga-
Applicant Name Address
City/State Zip
Phone
Contractor Address
Contractor City of Ft. Collins Sales Tax 9
Sales ray number is regu%ied by as Contractors
/oo zS3
City/State Zip
Are you paying taxes here or by report?
Are you paying with your trust account?
Phone
�O{ Here J(Report
g Yes O No
Is this a residential or commercial project? AResidential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) O Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank 13 Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
O Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes ONO If yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
!f prior to IY75, you wN geed an asbestos assessment to submit with this application.
Description of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: UstthecomoanynameOfCity &RCollinslicense0
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 will, 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: hef�l
Print Name
Signatur Date /a 30W