HomeMy WebLinkAbout1400 Greenstone Ct - Applications/Water Heater - 05/09/20129-039
Pt Collins
Planning, oevelopment & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 60524
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 I,a'SlVater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # 4&212.0 2.155
For office use only
Incomplete applications will not be accepted.
Date
lob site Address (required)
Value of Construction (labor, materials, profit)
0
Property Owner Name
Address
City/State Zip 5S;;.S Phone
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Applicant Name
Address
City/State Zip Phone
Contractor
Address
City/State Zip Phone
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Contractor City of Ft, Collins Sa ax #
Are you paying taxes here or by report?,Erl3ere ❑ Report
Ofestax numberisiegwredbya#con&a[tors.
Are you paying with your trust account? ❑Yes ,
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: mangle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit whir this application.
Description of work
*If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Su bco ntracto rs: List the company name of Gty of Ft coffins license #
Electrician Plumbed' LMechanical 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
Date � i / [ I
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