HomeMy WebLinkAbout1504 Teakwood Ct - Applications/Water Heater - 01/12/2012JAN-12-2012 15:36 From:Allen Service 970 484 4448 To:92246134 Paee:5/9
City of
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). El Air Conditioning
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit O Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
O Ventilation�Water Heater ❑ Water Line ❑ 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 # ao atiI I Date
For office use only
job Site Address
Owner Name Address
Applicant Name Address
Value of Construction (labor, materials, profit)
L-0 8QZ57.l 54 41g01400
City/State Zip Phone
City/State Zip Phone
Contractor Address City/State Tip Phone
Allow r 4 � ma 4?q-q-9411
Contractor City of Ft. Collins Sales Tax 9 Are you paying taxes here or by report? ❑ Here Report
Sakes tax number is rnquk;ed by a#corrfractoa Are you paying with your trust account? X Yes O No
o C1 / n
Is this a residential or c mmercial project?esldendal O Commercial
If residential, is it: mgle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) O Garage 4
If commercial, is it: ❑ Bank ❑ Bar CI Church O Hotel/Motel O Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes 0 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
0 prior to 197S, you will need an asbestos assessment to submit will) this applicat/on.
Description of work
*If lawn sprinkler/backFlow preventer, must list licensed plumber, if first-time A/C, must list licensed electrician.
Subcontractors: Lkst the company name or City offtCollins license A'
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. Signatur Date _