HomeMy WebLinkAbout837 Balsam Ln - Applications/Water Heater - 08/05/2014FROM :NCR
FAX NO. '9702299983 Aug. 05 2014 03:00PM P4/6
Cl� f Planning, Development 6t Transportation
Fy O281 N. College Ave P.O. Box 580
ort Cotlins 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 17 Sewer Line ❑ Photo -voltaic
❑ Ventilations Water Heater ❑ Water Line IDWood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer
Complete all applicable Information on the application. incomplete applications
sslwill not beeJaccepted. � j
Application # Date ek —i
For office use an/y
Sob Site Address (required)
Value of Construction (labor, materials, profit)
operty Owner Name Address
city/state Zip
Phone
,�
✓t t uoZ
7 ` (,
jixxeCfc 0. �2,4
3'
Applicant Name -�'^�-' Address
Sc
A.
City/State ZIP
Phone
Contractor Address
City/State P�Wli1rv�Zlp
Phone Of')-o
o ✓-f h ✓ L �-�a ✓ v> c , �(�S
Co YM z,4
Contractor City of Ft. Collins Sales Tax #
.......
Are you paying taxes here or by report? _*ere
0 Report
Solos tox number Is required by all wntractors.
Are you paying with your trust account? yes
❑ No
Is this a residential or commercial project? ,.4 Residential ❑ Commercial
If residential, is It: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamlly (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explai )
Is this building 50 years of ape or more? ❑ Yes /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 wll/ need an asbestos assessment to submit with this applicabbn.
Description of work
*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 Nam
Date