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HomeMy WebLinkAbout3507 Colony Dr - Applications/Water Heater - 03/22/201231012, Fort of 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). ❑ Air Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation VWater Heater ❑ Water tine ❑ 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. V Application # 1 I.© L I e 1 Date For orrice use only Job Site Address (required) /r Value of onstruction (labor, materials, profit) 7 WGA OR 5 , L90 Property Owner N Address G)LP 5 �SDav� 'D�e' rT City/State ZIP Phone lock its cv 8�526 9�-z2����2 Applicant Nye Address City/State Zip Phone r 1ov4mk-.(1S Saua&be_lorr o tract Address City/State ZIP Phone bDffiE.bnssell55e)0. �� 352G6 '�6b-(g12,-5a`f3 GC�a Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report ❑ No sales �-tadnuw� fequiredbyail contractors. Y Are you paying with your trust account? B-&s JRU 3t Is this a residential or commercial project? X Residential ❑ Commercial If residential, is It: Q Single Family Detached C] Condo/tAwnhome (single family attached) ❑ Multifamily (apartment) ❑ Garage If commercial, is it: Q Bank Q Bar Q Church ❑ Hotel/Motel 0 Medical office ❑ Office ❑ Duplex ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes 1XNo Ifyes, you mayneed to contact N/storiePreservahon If this is for a demolition permit, what year was th6 building constructed? Ifprior to 1975, you will need an asbestos assessment to submit with this application. Description of work a+ClPl *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: tlst the company name or City of Ft Collin license .# 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: �,7^� S F Print Name. ------- � Signatu 5112- 1 �. 100 'd 8L96-690-ZOL 'OK M AN-IVDINVH33W V113Q Wd 99 : ZO I1Hd,/Z I0Z/ZZ/9W