HomeMy WebLinkAbout3009 Ringneck Dr - Applications/Water Heater - 06/04/2012Ckyof
Fort Collins
OVER-THE-COUNTER
This application is to be used to apply for the following perrr
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement
❑ Ventilation Water Heater ❑ Water Line ❑ WoodfPellet St
manufacturer).
Complete all applicable information on the application. Inco
Application #
For oXce use only
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
ITS ONLY
only (check all that apply): ❑ Air Conditioning
vice change) ❑ Gas Lighter ❑ Gas Log
I Roofing ❑ Sewer Line ❑ Photo -voltaic
(must be EPA certified, provide make, model and
applications will not be accepted.
lob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Nam Address
City/State Zip Phone
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Applicant Name Address_
City/State Zip Phone
Contractor Address
City/ fate ZIP Phone
Contractor C
ty of Ft. Collins Sales TaQ #
Are you paying taxes there or by report? 12-Here ❑ Report
Sales raxnumb
risreQuiredbya#mnvacro s.
Are you paying with your trust account? ❑ Yes El -No
Is this a resi ntial or commercial project?. ..Residential ❑ Commercial
If residential, is it: .Mingle Family Detached ❑ Condoltownhome (single family attached) ❑. Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain) J
Is this buildin g 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact HistodcPreservation
If this is for a demolition permit, what year was the building constructed?
If prior to 19 S, you will need an asbestos assessment to submit with this application.
Description of work jsPyl A[^ o IM _L A-(o (b-<CtA2.A N2f2�lf�
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or City of Ft CoNins license 4
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 Nam Signat Date L i
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