HomeMy WebLinkAbout3724 Bromley Dr - Applications/Water Heater - 09/25/2014 (2)10-03-14;01:44PM; ;970-484-4448 # 5/ 11
Fort Collins
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
Cl Heating Unit / ❑Lawn Sprinkler 4 Mobile Home replacement ❑Roofing ❑ Sewer Line ❑Photo -voltaic
❑ Ventilation 7 Nater 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.
Application # 1?:>1410-1 LoLy Date
For office use only
Job site Address aired)
Value of Construction (labor, materials, profit) S
Property Owner me
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City/state Zip Phone
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Applicant am
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Address
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. City/State Zip Phone
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Contractor
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Address
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Clty/State Zip Ptione
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here Report
Sales rernumbIrlO /�eyalicnnoacmrs.
Are you paying with your trust account?�Yes []No
Is this a residential or cgmmerdal project? Idential ❑ Commercial
If residential, is it: 2942ngte Family Detachd5d ❑ Condo/townhome (single famlly attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office Cl Retail
❑ Restaurant ❑ other (explain)
Is this building 50 years of age or morel 13 Yes Cl No Ifyes, you mayneed to contactHIstoricPreservatlon
If this Is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with thIS appllcadon.
Description of work
"If lawn sprinkler/baddlow preventer, must fist licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust ft company name or OtyofRCoillns //tense #
Electridan 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: 1 n
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