HomeMy WebLinkAbout502 Strachan Dr - Applications/Water Heater - 01/27/201201/31/2012 11:55 FAX
0001
CityOf Planning, Development & Transportation
F6�C 281 N. College Ave P.O. Box 580
r } l Collins Fort Collins, CO 80524
`.- Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to bs 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 Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement C3 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all appl qai5
le information on the a Iwation. Incomplete applicat'ons will not be accepted.
Application # 0I'� 7 Date (�' :)
For ofi9Ce use only
Job Site Address (requ/red) Value of Construction (labor, materials, profit)
.tea FC , ?19 , U 0
Property Owner Name Address City/State Zip Phone
lMa,r/ee ��l.6s lfer— SD ac�Grct �L Z5�1, 6D ��
7e C�L -
Applicant Name Name Address 43, iya n Clty/State Zip Phone
Contractor Lic # Address
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all con"acrs
City/State Zip
Phone
Are you paying taxes here or by report? 0 Here ❑ Report
Are you paying with your trust account? ❑ Yes . JA No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, Is It: ❑ Single Family 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 more? ❑ Yes ❑ No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prlor to 1975, you wi// need an asbestos assessment to subm/t with this appl/Cadon.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or ply of Ft Co/l/ns //tense 0
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 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: I��VQ1T� �, -Signature J Date h,