HomeMy WebLinkAbout5201 Fox Hills Dr - Applications/Water Heater - 03/07/2012Mar 071210:35a Hahn Plumbing
9704935325 p.1
1,--- F0e; t Coffins
Planning, Development & Transportation
281 N. College Ave P,O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22'r-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 ncn-structural; ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit :1 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line , ❑ Photo -voltaic
C veniiiation Water Heater ❑ Water Line C 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 # bt � io
l I / v Date _ -7 _
For offce use only
Job Site Address (required)
Value of Construction1 (labor, materials, profit5-a)
Property Owner Name
Address
City/State Zip Phone "
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Applicant Name
Address
City/State Zip
Phone
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Contractor
Address
City/State Zip
Phone
Contractor City of Ft. Collins S
s Tax # M P- / 5-
Are you paying taxes here or by report? ❑ Here
-XRePort
saves tax num�eris required by all contractors.
In 6)
Are you paying with your trust account? g Yes
❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If resldenllal, is it: Single Famiiy 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 mere? Cl Yes ❑ No if yes, you may need to contactHlstoricPreservatlon
If this is ;or a demolition permit, what year was the building constructed?
ff prior to 2975, you will need an asbestos assessment to submit with this application.
Description pf work
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v Gl A
lewn s?rinkler, backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Lstrtecompany namsorCity ofFCCalllnslicense.p
Eiecc ician 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 wi;h 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: II ,� �/ ¢
Print Nam L( r1�1 rn S"7 (' n .y r Signature`���=-'i J l'L Date _ J