HomeMy WebLinkAbout1531 W Swallow Rd - Applications/Water Heater - 03/19/201203-19-12;08:30AM;
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Fort Collins
Planning, Development 8L 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). O Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation Kwater Heater O 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 # �)) M 139 a Date l oZ
for ofte use only
Job Site Address ftcLulreo
Value of Construction (labor, materials, profit)
S \
Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
Clty/State Zip
Phone
Contractor
Add ess
�o
Clty/State Zip
Phone
?053
6034
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? KHere ❑ Report
sales amnumber/smqubedbyall centraeftrs.
Are you paying with your trust account?
D(Yes ❑No
Is this a residential or commercial project? 9 Residential ❑ Commercial F_r^rnrlr
If residential, Is it: C(Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex Lkj'c) ;
❑ Multifamily (apartment) ❑ Garage b
If commercial, Is It: 0 Bank D Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail 7 5,4
0 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 0 Yes 17 No Ifyes, youmayneed to contact HistoricPreservadon
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you w/ll need an asbestos assessment to subm/t with tbls appl/cat/on.
of work =
�_ _ovnIQXE_�a .Nak=z-J — rary4r1;ACV%LCr
*If lawn sprinkler/badcFlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: UstMecompanyname crC/tyofFtColl/nsficimse#
BecMcJan 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:
PrinttName: nrl I'i a496 T Signature Q l ar y Date3�