HomeMy WebLinkAbout1218 Silk Oak Ct - Applications/Water Heater - 05/25/2012 (2)MAY-25-2012 15:57 From:Allen Service 970 484 4448 To:92246134 Pa9e:10,'10
City of
Fort Collins
Planning, Development &Transportation
Z81 N. College Ave P.Q. Box 580
Fort Collins, CO 805Z4
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) CI Gas lighter Q Gas Log
❑ Heating Unity❑ Lawn Sprinkler Q Mobile Home replacement ❑ Hoofing 0 Sewer Line , 11 Photo -voltaic
❑ Ventilation Nater Heater ❑ Water Line ❑ WoodtPellet Stove (must be EPA certified, provide make, model and
manufacturer).,!
Complete all applicable information on the application. Incomplete applications will not be accepted.
Applicakion # e I o 03a
For offrce use only
Job Site Address freouiredi
9,
T �G
Date 5_ _/ r'
Value of Construction (labor, materials, profit)
CO 2069S . A0I0
Property Owner Nam,, Address Gtv/State Zia
-2�uso � 4 T 5��.... ,
Applicant Name Address City/state zip
Contractor Address City/State Zip
405�
Contractor City of Ft. Collins Sales Tax 9 Are you paying taxes here or by report?
Sales rax number is req+Rr€d 6Y do rorrlydctart Are you paying with your trust account?
Phone
�D(, —9
Phone
U.4x4.4 941
Phone
14Se-l—
❑ Here j( Report
Yes ❑ No
Is this a residential or gornmerclal project? es entlal ❑ Commercial
If residential, Is it:Single Family Deta ed do/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) O Garage `
if commercial, Is it: ❑ Bank 11 Bar ❑ Churrh ❑ Hotel/Motel 17 Medical office • 0 office 0 Retail
❑ Restaurant ❑ Other (ex aln)
Is this building 50 years of age or more? ❑ Yes AND It yes, you may need to contact Historic Vfeservation
If this Is for a demolition permit, what year was the building constructed?
,rf pryor to 197S,, you wit/need an asbestos assessment to submit with Ws application.
Description of
*If lawn sprinkler/backhow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: at the company name or City of Ft Collins license 0
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
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: ��Qrrf lJ(In1A
Print Name: signatur pate Q�