HomeMy WebLinkAbout1918 Angelo Dr - Applications/Water Heater - 05/04/2015C[ty of
F®rtr CoWns
Planning, Development 9. Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER- HE-C'o NTEI°' PERRIMUS 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 XWater 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 # 5150-5 'R Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
v 1
-1900
Property Owner Name
Address City/State Zip
Phone 42o_
Applicant Name
Address City/State Zip
Phone g y�
lez
Contractor
Address City/State Zip
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Phone
65!®�
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Voroefn
Contractor City of Ft. Collins Sales Tax #
%7� Are you paying taxes here or by report?
El ) 1IReport
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes GCS No
Is this a residential orq commercial project? IM Residential ❑ Commercial
If residential, is it: - Single Family Detached ❑ Condo/townhome (single family attached) ElDuplex
❑ 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 Th No Ifyes, you may need tfact Historic Preservation
If this is for a demolition permit, what year was the building constructed? IL/
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. I know that a
permit is not valid until it has been paid and issued.
Applicant: /� 1
Print Name: Signature Date
07