HomeMy WebLinkAbout817 Prescott St - Applications/Water Heater - 12/26/2014Resendl2-26-14;07:27AM; ;970-484-4448 # 8/ 17
For t Collins
'Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+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 Un``````itt�11 C] Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line 17 Photo -voltaic
❑ Ventilation Water Heater ❑ Water tine d Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)
Complete all appflliicable information on the application. Incomplete applications will not be accepted.
Application * 1��� k` Date . �0�—ai 67— %
For 0n9ce use only
Job Site ress (mqu/red)
91 �L
Value of Construction (labor, materials, profit)
o5�5 C g -
Property Owner N e Address
City/State Zip
Phone
-323-i9slo
ppilcant Nam Address
Sherc; Z;r'�{1'tJ i ! - Ljm
aty/State Zip
kasAg
Phone
q7rv.ygq.qg11
ntractor Address City/State Zip
4 hlJ K Am Pd 60 M0oFol
Phone
yIy 11ml
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here i port
'O❑
Sales tax nwnberl u/redbyallconbuemm
�t7��0
Are you paying with your trust account?
Yes N o
Is this a residential or c mmercial project? ]� idendal ❑ Commercial
If residential, is it; `4Singie Family Detacifed ❑ 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 morel ❑ Yes ❑ No ffyes, you mayneed to cantacbH/ston'ePreservatlon
If this is for a demolition permit, what year was the building constructed?
.Upn'or to 1975, you will npqan asbestos assessmenttasubmit with this appllmdon.
Description of work
*If lawn
preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ustthe company name orO[y of Pe Colling l/cense &
Electrician Plumber Mechanlml 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 • ith A ' Signature Date + � -04
Print Name; r! 7