Loading...
HomeMy WebLinkAbout1625 Enfield St - Applications/Water Heater - 08/29/2014F®rt of 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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ 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 # �3 Q 4- b-6 61 A Date _'9 l `� 1 For office use only Job Site Address (required) Value of Construction (labor, materials, profit) Property Owner Name l Address City/State Zip Phone �1 ell, �,-5 ZO aS� I ,5 Applicant Name Address City/State Zip Phone W P S T ,,-� P© ;r 74y 4,," ), J (fo 5135 308-922C Contractor "� r`L, Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # 7� Are you paying taxes here or by report? dHere ❑ Report Sales tax number isrequired byall contractors. Are you paying with your trust account? ❑ Yes Wo Is this a residential or commercial project? `Residential ❑ Commercial If residential, is it: arSingle 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? Ifpnor to 1975, you will 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 company name or Ci of Ft Collins license # Electrician Plumber V 7� 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 regula ' uilding construction. I know that a permit is not valid until it has been paid and issued. Applicant: Print Name: Signature Date —�