HomeMy WebLinkAbout1718 Barnwood Dr - Applications/Water Heater - 05/04/2015May 041511:43a , Colorado Plumbing, Inc.
9704756267 p.2
City of
111'FF6rrt Collins
Planning, Development & 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 'X 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.
Applicatio #; �l I �( Date
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Sob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip
Phone
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Applicant Name City/State Zip
Phone
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Contractor Address City/State Tip
Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here
L] Report
sales tax numberlsrequlredbyallcontractom Are you paying with your trust account? ,Lf Yes
❑ No
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Is this a residential or commercial project? ELResidential ❑ Commercial
If residential, is it H Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ 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 )1 No If yes, you may need to contactHistodc Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 19.23, you will need an asbestos assessment to submit with drls application.
Description of work
*If lawn sprinkler/backflcw preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Listdre mmpanyname orCoe offtCollinslitense 0'
Electridan Plumber Mp_ `!�') Mechanical Roofer Other
1 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 Name: i 1 +I,rliM,j -JAI dA- Signature r4ilr� r/I:11.1011r paw