HomeMy WebLinkAbout5224 Mcmurry Ave - Applications/Water Heater - 02/07/2015Resend02-07-15;01:44PM; ;970-484-4448 # 6/ 11
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 13 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
11 Ventilation Water Heater 11Water 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 a +�~�
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For office use only
Date
Job Site Address (r quf 9
Value of Construct n (labor, material,Gprofit �Q
96
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rty Owner Name
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Address
5arne,
City/State Zip Phone
q 70 a A 5 a563
Applicant NaM91
Sherri ri -9"n
Address
/D ii S. f, itik
City/state Zip Phone
4N• FL C.0 T05ay qy0-qgq^ yggl
Contractor
Address
City/State Zip Phone
o / S- thV4
1,N. G a Yd59 �/fV yPyl
Contractor City of Ft. Collins sales lax #
Are you paying taxes here or by report? ❑ Here Report
Soles tax number is required by all contractors.
/1)d/A
Are you paying with your trust account? )Yes ❑ No
Is this a residential or c mmercial project? Residential ❑ Commercial
If residential, Is it: Single Family Detached ❑ Condo/townhome (single family attached) El Duplex
Multifamily (apartment) ❑ Garage
If commercial, Is it; ❑ Bank ❑ Bar 11 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building so years of age or more? ❑ Yes ❑ No If yes, you may need to contact HlstodcFreservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will neqlan asbestos assessment to subm/t w/th this application.
Description of work _� _W�TYIQ v � L 1�4 Y_ w064 .r r f I-C wr -Gr C&L I vt
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*If lawn sprinkler/backFlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Zkt the company name or Cky of Ft Coll/ns Jrcense d
Electrician Plumber Mechanlcal Roofer Other
I hereby acknowledge that I have read this appllcation 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: 1 A;j'1^7r1�
Print Name, i Ir1 VV!! �I Ffthr signatures ate Ol