HomeMy WebLinkAbout718 Powderhorn Dr - Applications/Water Heater - 12/19/2014FROM :NCR
FAX NO. :9702299983 Dec. 19 2014 03:15PM P3/3
F®rt Colima
Planning, Development 8c 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 Water Heater 0 Water I_Ine ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
mamdacturer).
Complete all applicable Information on the application. Incomplete applications will not
�be� accepted.
Application # IF:A4i 21 -1� • Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Addres Clty/State ('� zip
Phone
zaas
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
Clty/State F}C AWt Qlp
Phone (:'/7'M
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i`. 21 ZS
Go 9os Z4
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ere
❑ Report
Sales tax number isrequired byallcontractors.
0 (12J' (o of
Are you paying with your trust account? as
❑ No
Is this a residential or co menial project? Residential ❑ Commercial
If residential, Is it: Single Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church C3 Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes Z No Yyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Zf poor to 1975, you will need an asbeshzs 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 .e
Mertridan Plumber Mechanlcal_.__._._,,. 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:
Print Nam
Date ► 2� S ,__