HomeMy WebLinkAbout6401 Constellation Dr - Applications/Water Heater - 04/23/2014Apr 10 14 08:02a Rues, LLC .970-619-8074 p.1
CA
Fort 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 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. U 2• tel
Application Date Ptptz 23 • 20 ��}
Sob Site Address (requ6ed)
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Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip Ph ne
Applicant Name Address
City/State Zip Phone Qio`
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Avz Lover a- ',0 30531 us5 - 4 52 1
Contractor Address
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City/State Zip Phone
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Contractor City of R. Collins Sales Tax # `i
Are you paying taxes here or by report? (V Here 0 Report
Are you paying with your trust account? id Yes ❑ No
.Safes tax number is required bya#corKr dam
Is this a residential or 9mmercial project? It� Residential ❑ Commercial
If residential, is it U Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex'
❑ Multifamily (apartment) ❑ Garage
If commercial, is it:. ❑ Bank ❑ Bar ❑ Church L] Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes O No if yes, you may need to contact Historic Preservabon
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backnow preverder, must list licensed plumber. H first-time A/C, must list licensed electrician.
Subcontractors: List lire company name or City of Pr CoMns r<centse #
Electrician Piurrdrer Mechanical Roofer
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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:
Print Namea -v (JA C/ Signature
Date J 2 [A