HomeMy WebLinkAbout1632 Fantail Ct - Applications/Water Heater - 05/13/2015May 0515 09:48a Swan Heating and Air
970-613-0826 p.1
City. of Planning, Development&Transportation
F�.} { . 281 N. College Ave P.O. Box 580
6! t Collins 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 Aiterition (not service change) ❑ Gas Lighter ❑ Gas Log I _ `
A Heating Unit ❑ awn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic �J
0 Ventilation ater 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 # f✓ 5��1�
For office use only
Date _ �' «• �J
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
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Applicant Name Address
City/State Zp
Phone
Contractor Address
City/State Zip
Phone qR 1)
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Contractor City of Ft tAins Sales Tax #
Are you paying taxes here or by report?
I]Rlrgierp ❑ Report
Saks tax number isrequited ayall w &saws,
:Are you paying with your trust account?
&-Yves ❑ No
Is this a residential or comrvereial project? KrResidential ❑ Commercial
If residential, is it Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotei/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes a; If YeS, you may need in contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to I975, you will need an asbestos assessment to sibmit 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 /%tense
Electrician Plumber Mediankal Roofer
110011
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 - � -1