HomeMy WebLinkAbout1948 Promenade Way - Applications/Water Heater - 03/07/201203/24/2009 05:32
#0082 P.001 /001
11i15 Fort Collins,000
Phone 970-416-2740 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). EI Air Conditioning
D Demolition (interior non-structural) ❑ Electrical Alteration (not service change) O Gas Lighter ❑ Gas Log
0 Heating Unit D con Sprinkler ❑Mobile Home replacement D Roofing ❑ Sewer Line [IPhoto-voltaic
O Ventilation QoWater Heater D Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). .
Complete all applicable information on the application -
Application # R 2o
For o/7e e use ortty
Job Site Address (required)
property Owner Name Address
Name Address
Co tr ttor \LPL- # Address
City of Ft Collins Sales Tax #
Sales pxnum isrequiredbya//aonbaUws
Incomplete applications will not be accepted.
Date
value Construction (labor, matsriaiSr profit)
� �QQ
City/State Zip Phone
aty/ate Zip Phone
r,7C C0 Mad 9-70,Qoy,i
City/State Zip Phone
Are you paying taxes here or by report? D li5e &4el
Are you paying with your trust account? Mlles ❑ No
Is this a residential or commercial project? ❑ Residential 0 Commerdal
If residential, is it 17 single Family Detacw 0 Condo/townhome (single family attached)
❑ Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ Bar C7 Church ❑ Hotel/Motel ❑Medical office ❑ office
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? D Yes ❑ No If yes, You play need t° contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you wit/need an asbestas assewflent to submit w/tb this applAG"17.
Description of work
list
❑ Duplex
❑ Retail
Subwntractom Lat the company name or Otpy of ft Collins license #
pe&idan Plumber D2 — Metanical Roofer I OU1er
I hereby admowiedge that I have read this application and state that the above infvrmadon is complete and correct I agree to
comply with all requirements contained herein and city ordinances and statelaws regulating building construction. I know that a
permit is not valid until R has been paid and issued.
Applicant: Date 3 2�
print Name: Signature