HomeMy WebLinkAbout3009 Ringneck Dr - Applications/Water Heater - 06/04/2012 (2)of
Fart 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) ❑ Electrical Alteration (not se ice change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 11 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ZrWater Heater ❑ Water Line ❑ WoodiPellet Stov (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incom lets applications will not be accepted.
Application # Date
For ofYlce use only
Job Site Address (required)
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Value of Corrstruction (labor, materials, profit)
$
Property Owner Nam Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
Contractor Address
Zip Phone
City/C
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Contractor C
Sales tax number
ty of Ft. Collins Sales Tag#
is fequked by aq conmacnom
Are you paying taxes here or by report? Mere ❑ Report
Are you paying with your trust account? ❑ Yes [],No
Is this a
If reside
If
Is this buildi
If this is for
if prior to i
tntial or commercial project? .SET Residential ❑ Commercial
sit: .015ingle Family Detached ❑ Condo/townhcme (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
is it: ❑ Bank El Bar ❑ Church ❑ Hotel/Motel [I Medical office ❑ Office ❑ Retail
El Restaurant ❑ Other (explain)
150 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
demolition permit, what year was the building constructed?
Y,, you wil/ need an asbestos assessment to submit with this application.
Description of work'-KPyl c t75D GnL A)C_,) (x?CJeA NPL-t- P —
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orGtyofRCollins license 4
Electrician Plumber _02Mechanical 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.
ApplicantCc
:
Print Nam ! Signat Date'
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