HomeMy WebLinkAbout1724 W Stuart St - Applications/Water Heater - 08/01/2014cityFort
Planning, Development & Transportation
Fort Collins For N.College Ave P.O. Box580
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). I:] 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 # 'NI SO e?> Date 8/t 1194
For offim use only
Job Site Address Crequ/reo
Value of Construction (labor, materials, profit)
1124 0. ST v P--r Sr
Ct -A, Ct
Property Owner Name Address
Clty/State ap
Phone
f'7 M W. STU 4Ar Sr FT. COLLWS
93-6'161,
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
PAJiS PL04A_&1N/. r 147-6 P,p,Rax
ISSG [-WEZAHt>Co SDS37
9'70-&63-3f3
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
Here 17 Report
Sales taxnumberlsmqufredbyaticonbacfors
Are you paying with your trust account?
Yes El No
USE Pa:MBfNG Ok tryi4G TRusT F}tGT,
Is this a residential or commercial project? J�lkesidentjal ❑ Commercial
If residential, is it 0 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: E3 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building so years of age or more? ❑ Yes 13 % Ifyes, you may need to contactH&tNfc Praserualion
If this is for a demolition permit, what year was the building constructed?
Ypr/or to i975, you H,111need an asbestos assessment to submit wlifi ifiis application.
Description of work I?EPL ACC 4 0
*If lawn sprinkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orCty of Ft Collins license #
Bedridan Plumbar 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 regulating building construction. I know that a
permit is not valid until it has been paid and Issued.
Applicant: P►9ULS PLum$1`1`46
Print Name: SA&,LY l i ssfFL /3A-01 signature
Date ?// / / Y