HomeMy WebLinkAbout3623 Copper Spring Dr - Applications/Water Heater - 08/13/2014Aug 141407:51a Rues, LLC
e 970-61 MO74 p.1
City. of .
F6rt 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
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation IA 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 accepted.
Application # ??I+otAP)M Date
For of ice use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State
Zip
Phoned'-70
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Applicant Name Address
City/State
J Zip
Phone Q 10
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Contractor Address
City/State
Zip
Phone In '
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? 91-lere rJReport
Sates tax number /srequired bya#corrbactors
Are you paying with your trust account? IR Yes
❑ No
Old
Is this a residential or commercial project? C(Residential ❑ Commercial
If residential, is it: )t4 Single Family Detached ❑ Condo/town home (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 So 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?
Ifprior to I975, you will need an asbestos assessment to submit with this application.
Description of work
sprinkleribackflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
sutKontractors: List the coWanyname orCdyofFtCollins-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: — 11
Print Name, r P& (-1Y'�SJl Signature Q_ Date 3t 3
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