HomeMy WebLinkAbout7015 Avondale Rd - Applications/Water Heater - 10/13/2014From
10/13/2014 08:33 #370 P.001/002
�F�ort of
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 ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑.Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all apglicabie i ormT iog"on the applicat— Incomplete applications will not be accepted.
Application 1F � �' I,� Date
For office use only
Sob Site Address (required)
Value of construction (labor, materials,
profit)
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g z,a I �e
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
r
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? WHefe
40eport
Sales tax number is required by all contractors.
Are you paying with your trust account? )KYes
Cl No
Is this a residential or commercial project? Mesidential ❑ Commercial
If residential, Is it: 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 ❑ 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
rr lawn springer/Dacalow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Lfst the company name or City of Collins license #
Efectridan 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: (� `^ 1
Print Name: � \ LONE �NSignatureDate IiJ 1�31)y