HomeMy WebLinkAbout3019 Garrett Dr - Applications/Water Heater - 07/01/2015Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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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 ❑ 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 # 815049(01 Date
For office use only
Job Site Address (required)
V lase of Constructio (labor, materials, profit)
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Property Owner Name
Address City/State Zip
Phone
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-30J d mkxF -7- Dig, IC ('p 805'21� `i70- 39/-193_5—
Applicant Name
Address City/State Zip
Phone
Contractor
Address City/State Zip
Phone
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3600 %%ktp 7ac,71/ cT. c <D e0S2 1�
97a - 275'- 27k Z
Contractor City of Ft. Collins Sales
Tax # Are you paying taxes here or by report?
ETITere ❑ Report
saiestax number isrequired byall mntractom Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: ❑ 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 Zr No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
rPL
*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 license #
Electrician Plumber ^2 ZSy— 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:
Print Name: / /l6EA&L •�Ti t��, signature
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Date / S