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HomeMy WebLinkAbout4121 Cedargate Ct - Applications/Water Heater - 05/15/2012City of Fit Cotti IS 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). Q Air Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler Q Mobile Home replacement ❑ Roofing ❑ Sewer Line Q Photo -voltaic ❑ 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 # i/ 10 oz 1(�`� For affice use only Date 51 (51 , -I lob Site Address (requfred) Value of Con uction (labor, materials, profit) Ll o-1 2 'i)v- AW149 - o 0 Property Owner Name Address City/State Zip Phone aSRL%c`�o�`a�v� 442.4 CizA ka �qft Cl &At> q40 � 215- BIND Na e A ress City/state Zip Phone Micant o kCS Same ashe lorr qc�tra Or A�ddrrees�li��� City/State Zip Phone 13 �° s �� $5Z0ok gUo(bq9)-6D 155 GcSa Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report files sales ra be �SreQ�edbyallcono-acmrs. Are you paying with your trust account? 13 ❑ No b g \JRU (St Is this a residential or commerclal project? A Residential ❑ Commercial If residential, is it: 0 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Multifamily (apartment) ❑ Garage If commercial, Is it: © Bank ❑ Bar CJ Church ❑ Hotel/Motel IJ Medical office ❑ Office ❑ Duplex ❑ Retail ❑ Restaurant Q Other (explain) Is this building 50 years of age or more? ❑ Yes %No . If yes, you mayneed to contactNistoric Preservation If this Is for a demolition permit, what year was th¢ building constructed? If prior to 1975, you will need an asbestos assessment to submit with this application. Description of work J *If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Llst the company name or city of Ft Collins license # Electrician ?lumber. 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: Prin Print Name: 51151 12 Z00 'd HS6-15K-ZOL 'ON M AN-1VOINVU3W V11311 Wd SZ:M HI/ZIOZ/SIAM