HomeMy WebLinkAbout2407 Cochetopa Ct - Applications/Water Heater - 10/08/2014 (2)of
Fort 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 UL 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 # e 9 tj Q :324 S Date I ca o f I LI
For office use only
n Value of Construction (labor, materials, profit)
]cab Site Address (required)
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City/State ZipPhone s 10 ,
Property Owner Name Address j05a 5
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Address City/State Zip Phone R1o"
Applicant Name �5 _ 6 1 ` I
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Address City/State Zip Phone
Contractor f
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Contractor City of Ft. Collins Sales Tax # U Are you paying taxes here or by report? (WHere 1PReport
Are you paying with your trust account? Yes ❑ No
sales tax number is required by all contractors
Is this a residential or commercial project? P Residential ❑ Commercial
If residential, is it: q 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 5o years of age or more? ❑Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
S VQ
*If lawn sprinkler/backFlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orCity ofFt 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: a y i- L JYJ-, - Signature
Print Name
Inr Sl l�
Date
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