HomeMy WebLinkAbout825 Cambridge Dr - Applications/Water Heater - 04/21/201404-23-14;07:56AM; ;970-484-4448 . # 14/ 15
Fort Collins
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
❑ Demolition (interior non-structural) D Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas log
17 Heating U it ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line O Photo -voltaic
ElVentllation Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacture
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #?14022271 Date �`� �•%�
for &rim use only
Job Site Address (required)
69th 7Q.
Value of construction (labor, materials, profit)
8 br,'_ofqg
rC L D kams'
D
.
perty Owner Name Address
Clty/State Zip
. Phone
b
32
Applicant NameA Address
city/state Zip
Phone
' . Ll
r�0
q70• /
ntmctor Address
. City/State Zip
Phone
krilto s• k &
Am. P6 a 8'0670
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
C1 Here Pkeport
sales twnumberio� �byaUmnbae"Is'
Are you paying with your trust account?
Yes ❑ No
Is this a residential or mmerdai project? Pkilesidential ❑ Commercial
If residential, is It Single Family Deta ed ❑ Condo/townhome (single family attached) ❑ Duplex
17 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑liar ❑ Church ❑ Hotel/Motel ❑ Medical office O Office ❑ Retail
13 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes ❑ No TfYa$ you may need to contact H1sforlc Preservation
If this Is for a demolition permit, what year was the building constructed?
1f prior to 19750 you W11 need an asbestos assessment to submit with thisdppficab'on.
of work
*If lawn sprinkier/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractorsr Ust Me company name or oty of FeCNIIns license 0
Eledridan Plumber Medianlcal 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: rl CriAn*signaturelAek"Date
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