HomeMy WebLinkAbout2625 W Stuart St - Applications/Water Heater - 04/20/2012APR-25-2012 09:16 From:Allen Service 970 484 444e To:92246134 Paoe:10,'12
City of
,rort 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) O Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing 0 Sewer Line ., ❑ Photo -voltaic
❑ Ventilation XWater Heater ❑ Water Line 0 WoodtPeilet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. incomplete applicaations will not be accepted.
Application # ' �� e3 Date
For oB9ce use only
Job Site Address rreouired) Value of Construction (labor, materials, profit)
Lo2.5� �va4 q.
�to 9/d�"a& llaalim
Pr Owner Na � Address C1ty/State Zin � Phone
�� ii a day -
Applicant Name Address City/state Zip Phone
.S06 P.J-V-49-494t
Contractor Address City/State Tip Phone
41 LAY, a. pnl rids, Co Tosay q,?q- qg4ll
Contractor City of Pt. Collins Sales Tax # Are you paying taxes here or by report? Cl Here Report
sates tax number Is required by as cantmcears Are you paying with your trust account? )K Yes ❑ No
to Cl/�
Is this a residential orj0 ienia] project? �Residentlal ❑ Commercial
If residential, is it: ).[Single Family Detach ❑ Condo/townhome (single family attached) ❑ Duplex
❑`Multifamily (apartment) O Garage
If commercial, Is it: 0 Bank 0 Bar ❑ Church ❑ Hotel/Motel l3 Medical office • rms Won�fR'*Giral draft
❑ Restaurant E3 Other (expla )avoith dFaft hood
Is this building 50 years of age or more? 0 Yes ANo ff yes, you may need ( *t'tgW&%ffW1WR9ty
If this is for a demolition permit, what year was the building constructed? Ta^et-Prier iG final F^V^i
if prior to 1975, you will need an asbestos assessunnt to submit with this applicabon.
Description of work
tq'ir r to li .Q�(r r
*If lawn sprinkler/backfbw preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the Company name of City oft? Collins ikense R
Electrician Plumber
MediaNcal 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 ck ordinances and state laws regulating building construction, I know that a
permit is not valid until it has been paid and issued.
Applicant: h�f�t Ii1
Print Name: , ` 5ignatur - Date