HomeMy WebLinkAbout3039 Anchor Way - Applications/Water Heater - 11/04/2014Manning, Development & Transportation
i G N `,' L /I L v ll 281 N. College Ave P.O. Box 580
Co[� ms Fort Collins, CO 80524
j ^ Phone 970-416-2740 Fax 224-6134
OVER-THE40UNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). El Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation EI 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 accented.
Application # si5onzZ- Date
For office use only
Sob Site Address (required)
Vague of Construction (labor, materials, profit)
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Property Owner Name `� Address
City/State Zip i 0 ;d l) Phone '110
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Applicant Name Address
Ci�/State Zip Phone �( 7
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Contractor J Address
City/State Zip l Phone cii0
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? CI Here ❑ Report
Sales tax number is required by all contmctors-
Are you paying with your trust account? 19 Yes ❑ No
Is this a residential or commercial project? El Residential ❑ Commercial
If residential, is it: E. 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 Ifyes, 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
—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. E know that a
permit is not valid until it has been paid and issued.
Applicant: r� `,,, ! (w ' J : j \; li !V �, II Ll ( `.
Print Name: " l� J Siognature i ti ®ate