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Home My WebLink About1313 Burton Ct - Applications/Water Heater - 08/17/201208/17/2012 12:02 9704938020 PAGE 01/02 Fcity'okforCollins 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 ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing O Sewer Line ❑ Photo -voltaic ❑ Ventilation X 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. a Application # E 13-050L Date For office use only Sob Site Addi (required) Value of Construction (labor, materials, profit) 1313 Burton Court $1,094.00 Properly Owner Name Address City/State Zip Phone Home Solutions PO Box 662 Loveland, CO 80537 493-0025 Applicant Name Address City/State Zip Phone Bershinsky Plumbing & Heating P.O. Box 679 Fort Collins, CO 80522 493-4355 Contractor Address City/State Zip Phone Bershinsky Plumbing & Heating 1425 Lawton Lane Fort Collins, CO 80524 493-4355 Contractor City 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 21177 is this a residential or commercial project? ❑ Residential ❑ Commercial If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single Family attached) ❑ Duplex El Multifamily (apartment) G] Garage If commercial, is it: O Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ other (explain) Is this building 5o years of age or more? ❑ Yes E3 No If yes, you may need to contact Historic Preservation If this is, for a demolition permit, what year was the building constructed? If prior to 1975, you will need an asbestos assessment to submit with this application. Description of work Replace water heater *If lawn sprinkler/backtlow 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; Qill rshins SI9nature Date Aylgust 1717, 2012