HomeMy WebLinkAbout5112 Redbud Ct - Applications/Water Heater - 03/20/2015Resend03-30-15;08:05AM; ;970-484-4448 # 9/ 10
�XY O.J. 281 N. College Ave P.O. Box 580
CoLtIns Fort Collins, CO 80524
Phone 970-41616-2740 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 Uqtf ❑ Lawn Sprinkler IJ Mobile Home replacement d Roofing ❑ Sewer Line C3 Photo -voltaic
0 Ventilation Water Heater ❑ Water line 0 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 # E;,A'�E'0Date -3-/S_
Forofrrce one only
Jab Site Add r ( ul ed)
Value of Construction (labor, materials, profit)
Owner a e Address
Gty/State Zip Phone
WProrcra 5amie,
a013- 7 TE
Applicant Nam Address
City/State Zip Phone
ntractor Address
S. i
Gty/State Zip Phone
. P& 60 FOAI 1/ifN--Z/K/
Contractor City of FL Collins Sales Tax 0
SalestaxntrmboZ, Ulmdbyallcontraemrs
lD
Are you paying taxes here or by report? O Here Pkepart
Are you paying with your trust account?*.Yes 0 No
Is this a residential or merdai project? esidential ❑ Commercial
If residential, is it: 1 SIngle Family Detacifed ❑ Condo/townhome (single family attached) ❑ Duplex
i7 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ ear Ci Church ❑ Hotel/Motel 1 Medical office ❑ Office ❑ Retail
Q Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 0 Yes U No Zfyes, you may need to contactHistor/cPreservatlon
If this Is for a demolition'permit, whatyear was the building constructed?
Ifprlorto 1975, you coil/nWan asbestos assessment to submit with e'71s appllmeon.
Description of work
*If lawn spr(nkfer/badd'low
must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors.' W the wmpanyname or Gty afRGo/l/ns l/cense #
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: //11 hr�
Print Name: r I I� Signature bate '3—cm—/v