HomeMy WebLinkAbout5115 Fruited Plains Ln - Applications/Water Heater - 02/16/2015Ciof
Flirt Collins
OVER-THE-COUNTER
Planing, Development & Transportation
281 College Ave P.O. Box 580
Fort Ilins, CO 80524
Phon g70-416-2740 Fax 224-6134
This application is to be used to apply for the following permits
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not ser
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑
❑ Ventilation JI Water Heater ❑ Water Line ❑ Wood/Pellet Stove
manufacturer).
Complete all applicable information on the application. Incompl
Application # I�m I In
For office use only
ONLY
(check all that apply). ❑ Air Conditioning
change) ❑ Gas Lighter ❑ Gas Log
>fing ❑ Sewer Line ❑ Photo -voltaic
st be EPA certified, provide make, model and
applications will not be accepted.
.a- / I LP 115
lob Site Address (required)
Valu
of Construction (labor, materials, rofit)
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Property Owner Name Address
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Applicant Name Address
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Contractor Address
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Phone 9-70
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Contractor City of Ft. Collins Sales Tax #
Are you payin
j taxes here or by report? )S Here
❑ Report
sales tax number is required by all contractors.
Are you payin
with your trust account? VP Yes
❑No
Is this a residential or commercial project? 17\-Residential ❑ Commer
If residential, is it: C Single Family Detached ❑ Condo/townhome
Cj Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Me
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you n,
If this is for a demolition permit, what year was the building constructer
zronor to 1975, you will need an asbestos assessment to submit with this
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical
family attached) ❑ Duplex
office ❑ Office ❑ Retail
need to contact HistoricPreseruation
must list licensed electrician.
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 lav is regulating building construction. I know that a
permit is not valid until ithasbeen paid and issued.
Applicant: C (P.t i) VU ,� 1 C{ f s T i
Print Name: Signature /( i J Date