HomeMy WebLinkAbout808 Napa Valley Dr - Applications/Water Heater - 08/13/2012City of Planning, Development & Transportation
Fort Collins 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.
Application # , f Z ���� Date Ct A'T 1'l aQl z
For ofce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
�E,Q a N,4 e A - �Ajfv Ly $
Property Owner Name Address
Cii%ty/Statt+e[ /� /%
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Zip Phone
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Applicant Name Address
City/State
Zip
Phone
, 74` , -S 411�1 v e.
Contractor Lic # Address
City/State
Zip
Phone
Contractor ity of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential ommercial project? 0 Residential ❑ Commercial
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If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes X No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pr1or to 1975, you will need an asbestos assessment to submit with this application.
Description of work Chq iv r &ut��� 145 .11�, e�9 cr
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber 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: '
Print Name: ��'RrJ�S 124 �4&1 Signature Date Oil
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