HomeMy WebLinkAbout1554 Birmingham Dr - Applications/Water Heater - 06/30/201407-01-14;03:26PM; ;970-484-4448 # 18/ 18
City of
Flirt Collins
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO Bos24
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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Un���itIIt ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation Water Heater ❑Water Line IDWoodlPellet Stave (must be EPA certified, provide make, model and
manufacturer)/
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # 1�%�-0?,(�� (�, Date
Forott)ce use only
lob Site Address ulredp.
15'!T4jt'Rrn lN�
A n.i
Value of Construction (labor, materials, profit)
�a� 1917°
Property Owner Na a
Address
Ala-
City/State Zip
Phone
tgR7-/AI
/Y!e
6alne,
a 3
plicanc Ivan
tJ ! r
Address
1 1149
City/State 7Jp
W. PL 6I
Phone
q7'a• YMSyl
ntractor Address
i 5. i
City/State Zip
W. P(!i 60 5'059
Phone
Mil-118
n e e, l0 i
Contractor City of Ft. Collins Sales Tax
#
Are you paying taxes here or by report?
❑ Here Pkeport
salrsrwnumvar � qua dbyanrontradws.
Are you paying with your trust account?
.Yes ❑ No
Is this a residential or c mmerdal project? )N9 Residential ❑ Commercial
If residential, Is it Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Muldfamily (apartment) ❑ Garage
If commercial, is It: 17 Bank 0 Bar 11 Church ❑ Hotel/Motel ❑ Medical office 0 Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No !ryes, you mayneed to contact Historicftservatlon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will Wd an asbestos assessment to submit wiM this application.
of work
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 applloation 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 Nam
Date `� _2D / !