HomeMy WebLinkAbout531 Saturn Dr - Applications/Water Heater - 04/25/2012Ciof
Fort Collins
Planning, Development &Transportation
2BI 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 Q Lawn Sprinkler l7 Mobile Home replacement ❑ Roofing ❑ Sewer Line 0 Photo -voltaic
❑ Ventilation VWater Heater ❑ Water Line Q 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 # )120 Z2-F!�l Date��-
For office use only
Job Site Address (required)
Value of Con
truction (labor, materials, profit)
NA
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Property Owner Name j
Address
City/State
Zip Phone
L01 a�� 5 '
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90525 940- 2,06- R z1 �
Applicant Nye.
Address
Clty/State
Zip Phone
1 r lo�'L k_(.
:Same abbe. ot-4
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Address City/State
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Zip Phone
852a6
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? WHere ❑ Report
.salesraxnub required by allcontracmrs.
l� b
Are you paying with your trust account? [3'ffes ❑ No
/Mu St
Is this a residential or commercial project? Pq Residential ❑ Commercial
If residential, is it: M Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: 11 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 'lo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was th building constructed?
If prlar to 1975, you wN need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companynameorCity ofFtCollinslicensef
Electrician_ Plumber 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: Ebr�l� rri
Print Name: 1 `+I'�
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