HomeMy WebLinkAbout1533 Carmela Ct - Applications/Water Heater - 09/09/2014Resend09-09-14;10:11AM; ;970-484-4448 # 2/ 8
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
13 Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Llne ❑ Photo-voltalc
❑ Ventilation 1�Water Heater 0 Water Line ❑ Wood/Pellet.Stave (must be EPA certified, provide make, model and
manufacturer).!!! ��-
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # I+09373 Date
For office use only
Job Site Add Nqu/red)
la
Value of Construction (labor, materials, profit) pO
'
�l53
AA
Owner a Address
CI State zip
Phone •
JMA
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Applicant Nam Address
! L ru
Clty/State zip
W4 P6 a
Phone
quo• S • 6 q
:Xeiffij .
.905Aq
ntractor Address
leryf&
City/State Zip
AN,
Phone
907
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
O Here Pkeport
Sales tax number IMAred by all con&adfws
Are you paying with your trust account?
Yes O No
Is this a residential or commercial. project? Residential 0 Commercial
If residential, Is It: Single-Famlly Detac ed 13Condo/townhome (single family attached) 13 Duplex
❑ Multifamily (apartment) 13 Garage
If commerdal, is It: 0 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office U Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years/of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contact Hlstodcpreservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, youFw/1 need an asbestos assessment to submit with this application.
Description of work tseffioczle
x.
*If lawn sprinkler/bac <tlow preventer, must list Icensed plumber. If first-time A/C, must list licensed electrklan.
Subcontractors: list the company name or C/ly of Ft Collins license .#
Elechidan Plumber Mechanl®I 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 consovedon. I know that a
permit is not valid until It has been paid and issued.
Applicant:
Print Name: 1 n
.
Date I — EN