HomeMy WebLinkAbout3500 Carlton Ave - Applications/Water Heater - 06/30/201407-01-14;03;26PM; ;970-484-4448 # 15/ 18
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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 0 Sewer Line CI Photo -voltaic
❑ Ventilation pt,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 # ?5)4-0-�(o19 Date 6;3�L/q
Foroflice use only
lob Site Address (requimd)
Value of Construction (labor, materials,profit)
D � I✓ J
P operty Owner Name Address
City/State. Zip Phone
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Applicant Nam Address
PAW 1 / L1 �1
City/State Zip Phone
gof q7o• g • l
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tractor Address
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A
City/state Zip Phone
P& 60 $05a qfy- 8yl
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Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? 0 Here eport
saieswxnumberjOre$/nobya/�contractors
Am you paying with your trust a000unt?'% ❑ No
Is this a residential or commercial project? esi ential 0 Commercial
If residential, is it: ❑ Single Family Detach d Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial,. Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 13 Office 13. Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O No Iryes, you mayneed to con1uctH1storicPreserva11on
If this Is for a demolition permit, what year was the building constructed?
Ypr/or to 1975, you will need an asbestos assessment to submit with this app/Icaifon.
Descrlpdon of work
*If lawn sprinkler/back iow preveriter, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or oty of FtQ111ns l/canm #
Deebidan Plumber MeftnlCai 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: rl .n Signature Date -304