HomeMy WebLinkAbout904 Ponderosa Dr - Applications/Water Heater - 12/02/2014Resendll-06-14;03:13PM; .. ;970-484-4448 # 7/ 14
Fort Coffins
Planning, Development & Transportation
281 N. College Ave P.O. Box S80
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). 0 Air Conditioning
0 Demolition (interior nonstructural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 1lVater Heater 0 Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer) / _
Complote all applicable Information on the application. Incomplete applications will not be accepted.
1' r�� Date—��•lza ,
Application #� � � jA Z2.14
Pbr office use only
7 Site Addrpeyy (imuhed)
value of construction (labor, materials, profit)
9f101
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P operty Owner me
Address
CI State Zip
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Phone
aN one
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Applicant Nam
Address
Gty/State Zip
Phone
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Contractor
Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax
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Are you paying taxes here or by report?
Here ;iport
sales bxnumber�robya#con&vct".
Are you paying with your trust account?
.Yes ❑ No
Is this a residential or commercial project? �LResldentlal ❑ Commercial
If residential, is It: Single Family Detached ❑ Condo/townhome (single family attached) 0 Duplex
❑ Multifamily (apartment) Q Garage
If commercial, is it: 0 Bank ❑ Bar ❑ Church 13 Hotel/Motel ❑ Medical office ❑ Office 0 Retail
❑ Restaurant 10 Other (explain)
Is this building 50 years of age or more? O Yes O No Ifyes, you mayneed to mrrtect Hfst6JkFreservaA'on
If this Is for a demolition permit, what year was the building Constructed?
Ifpdor to 1975, you w/ll need an asbeseos asmwment to subm/t wlby bits app#cadon.
Description of work
i _ . w
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: fist the company name or 0y offtQ111f s license A' '
Eledaldan 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: Mr �
Print Name: i.1 J i n
JDate ` —[a rH