HomeMy WebLinkAbout2043 Tunis Cir - Applications/Water Heater - 07/29/201407-29-14;09:24AM; ;970-484-4448 # 3/ 10
Fort Collins
Planning, Development &Transportation
281 N. College Ave P.O. Box s8o
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 l7 Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line 13 Photo -voltaic
❑ Ventilation Water Heater Q Water Line 0 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 # !;fe _ I+O44eDate 7-;tq- il
For offce use only
Sob Site Address &Wulmd) Value of Construction (labor, materials, protll)
i r �% O 0
P erty Owner m • x Address City/State Zip Phone 3413
-►V 4 �0 A plicant NameA Address city/State zip Phone
ntractor Address City/State Zip Phone
Xio 1 &LAIX kq. P& U 90,561yPy 8
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? O Here Report
Sala taxnumberk60 Wbyall cono-act= Are you paying with your trust account?".Yes ❑ No
Is this a residential Qr �Pmmercial project? esidential ❑ Commercial
If residential, is It: �El.Single Family Detac ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank 0 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ OfRoe C3 Retail
❑ Restaurant 13 Other (explain)
Is this building '50 years of age or more? Dyes ❑ No IFyes, you may need to contactHIstwYcPresmwt/on
If this Is for a demolition permit, what year was the building constructed?
0pr1or to 1975, you W/11 n an asbeatns assessment M submit with this application..
Description of
*If lawn sprinkler/backtlow preventer, must list licensed plumber. If first-time AIC, must list licensed eiecbidan,
Subcontractors: List the mmpany name or Uty of Ft Collins liranse #
Elemiclan, Plumber Mechani®I Roofer other
I hereby acknowledge that I have read this application and state that the above Information is Complete and connect. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. X know that a
permit Is not valid until it has been paid and issued.
Applicants
Print Name:C,-, r^
Date 4��/7
t_V`77