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HomeMy WebLinkAbout645 Peyton Dr - Applications/Water Heater - 04/09/2012APR-10-2012 09:43 From:Allen Service 970 484 4448 To:92246134 Pa9e:7,'10 City of Fort Collins Planning, Development & Transportation 281 N. College' Are P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER IE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) O Gas Lighter ❑ Gas Lora ❑ Heating Uni ❑ Lawn Sprinkler ❑ Mobile Home replacement 13 Roofing ❑ Sewer Line. CI Photo -voltaic ❑ Ventilation Water Heater Cl Water Line ❑ WoodiPellet Stove (must be EPA certified, provide make, model and manufacturer). complete all applicable information on the application. Incomplete applications will not be accepted. Application # R'o oigo3 For office use onty Date "l �'�� �'DO Job Site Add ess frrzouined) Value of consMctlott (labor, materials, profit) /_ tl� . nD 114A A l il. F C G O V.6�a�" - 01&11•06 Owner AMP k 7TAI City/State Zia • Phone Applicant Name Address City/State Zip Phone ,ShI'xr� hY(Th IUI Ulin� Ua F-f,�olGhs G� X�>��` J40.49,494i Contractor Address Gty/State Tip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report $airs tax number is required by atl contraclarx Are you paying with your trust account? 9Yes ©No /0/n Is this a residential o*'lultifarnily mercial project? KResldential ❑ Commercial If residential, Is It:ngle Family Detached ❑ Condo/townhome (single family attached) O Duplex (apartment) ❑ Garage $ If commercial, is it: ❑ Bank ❑ Bar O Church ❑ Hotel/Motel ❑ Medical office • ❑ Office ❑ Retail ❑ Restaurant a Other (explain) Is this building 50 years of age or more? O Yes J9 No Iryes, you may need to contact HistorkAreservarron If this is for a demolition permit, what year was the building constructed? If prior to 197S, you will neeoan asbestos assessment to submit w/th this application. Description of work - ., *If lawn sprinkler/backflow preventer, must list licensed plumber. 1f first-time A/C, must list Subcontractors: List the company name orCilyofFtCollins licensed e is d'c;ombustion Safety prior to final approval Electrician Plumber Mechanical Roofer Other I hereby acknowledge that I have read this application and state that the above Information is complete and correct. 1 agree to cornply 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. r Applicant: bez%(I Print Name: Stgnatur Date