HomeMy WebLinkAbout721 Remington St - Applications/Water Heater - 05/01/2012May U4 12 11:U/a Ace HI Hiumbing Heating A y/U-2/6_14yU p.[
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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Horne replacement ❑ Roofing ❑ Sewer Line ❑ Photo-vottaic
❑ Ventilation fa'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 acce ed.
Application #�2.�2 Date Y�^
01.1
lob Site Address (required)
Value of Construction (labor, materials, profit)
4: a, .
Property owner Name 11j Address
City/State Zip Phone
Applicant NOQ Address
ity/State Zip Phone
Contractor Address
City/State Zip Phone
-) Lxnhat,� Nk L n i�c�
ci
Contractor City of Ft. Collins Sale T #
Are you paying taxes here or by report? $Here ❑Report
with trust account? ❑ Yes F.
Sales raxnumber isrequiredayammnt2
Are you paying your
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: .0"S'ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar l7 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building so years of age or more? ❑ Yes ❑ No if yes, you may need to contactHlstoric Preservation
If this is for a demolition permit; what year was the building constructed?
if pnor to 1975, you wi11 need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plu ber. If first-time q/oust list licensed electrician.
Subcontractors: List the company name Gty of Ft Collins license #
Ele[ViCian
Plumber Mmhaniral 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.
Applilcant:�.& Date _� J
Print Nam Signature Signature