HomeMy WebLinkAbout1818 Manchester Dr - Applications/Water Heater - 10/02/2014CI of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Forr t Collins 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 IR 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.
Vn
Application # Date 10/2/2014 �ou
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
1818 Manchester Drive
$800.00
Property Owner Name Address
City/State Zip
Phone
Dan Bucholt 1818 Manchester
Drive Fort Collins, CO 80526
970-481-8410
Applicant Name Address
City/State Zip
Phone
Dan Bucholt 1818 Manchester
Drive Fort Collins, CO 80526
970-481-8410
Contractor Address
City/State Zip
Phone
Rams Plumbing,Inc. PO Box 1495
Fort Collins, CO 80522 970-690-8997
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
0 Here ❑ Report
Sales tax number isrequired byall contractors.
Are you paying with your trust account?
❑ Yes XNo
# 42339
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: IS 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 50 years of age or more? ❑ Yes INNo If yes, you may need to contact Historic Presetvadon
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 Replacement of water heater with Navien NPE-240A tankless
*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 MP-534 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: Dan Bucholt Signature Date 10/2/2014