HomeMy WebLinkAbout1349 Stonehenge Dr - Applications/Water Heater - 04/29/2015Resend04-30-15;03:40PM; ;970-484-4448
Rio r t (oo-CiL,.tins Fort Collins, O 80524
�.� Phone 970416-2740 Fax 22+6134
COVER -THE -COUNTER PERMITS ONLY
Tills application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
p Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Un,,it11 ❑ Lawn Sprinkler ❑ Mobile Home replacement O Roofing Q Sewer Line ❑ Photo -voltaic
❑ Ventilation ya,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 # & 15 C).3I -I3 Date-41-a-1-15" -
farofflce use only
# 7/ 9
Job Site Ad s (requlr, J
Value of Construction Qabor, materials, profit)
.
�� �p ���-a� .o
Property Owner a Address
City/State zip Phone
ame S ,7- 7?9-j/C v
Applicant Nam9l Address
. r •� ! l . LIMP
City/State Zip Phone
�05 �70. 8 8i//
ntractor Address
ffin ire. /0 i
City/State Zip Phone
, P& a R0.501 Y l/ify yg !
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? HereReport
Sales rarnrmberli v1mdaya1/conbacionr. -
Are you paying with your trust aecounL? Yes ❑ No
is this a residential or c mmerdal project? $ Residential ❑ Commercial
IF residentiai, is
it: �Single Family Detach d ❑Condo/townhame (single family attached) ❑Duplex
❑ Multifamily (apartment) ❑ Garage
IF commercial, Is it: ❑ Bank Cl Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant E3 Other (explain)
Is this building 50 years of age or more? D Yes i] No Ifyes, you mayneed eb contact Hlsto11cPf=rvadon
If this Is for a demolition'permlt; what year was the building constructed?
IPpnor to .W5, you will need an asbestos assessment M submlt Wth this epplicadan.
Description of work
*If lawn sprinkler/backHow preventer, must list licensed plumber. If first-time NC, must list Ilrensed electrician,
subcontractors: Llstthe company name or CIty o,'R WlInsAmnse,Y
Electrician Plumber Mechanlcal Roofer. Other.
I hereby acknowledge that I have read this application and state that the above Information is templets 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:SPrint Name: r I r + % n Signature pate