HomeMy WebLinkAbout1717 W Drake Rd - Applications/Water Heater - 07/16/2015JUL/16/2015/THU 10:48 Alva FAX No. P, 002
V City! Of Planning, Development & Transportation
r+Collins281 N. College Ave P.O. Box 580
C 61 t CiFort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
N
OVER-THE-COUNTER PERMITS ONLY
10 This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
d Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit p lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
El Ventilation to 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 # 91 GD454-61CH.Date
For olAce use only
Job Site Address (raqulmd) Value of Construction (labor, materials, profit)
l"11'1AJ Cc 0) V;wl e&wn5l ft105Zl 101 l
Property Owner Name Address City/State Zip Phone
"io a S 46vc 11- 2"1
Applicant Name Address City/State Zip Phone
w/Co'�ntracto`r j� t_ Address city/State ZipPhone
Irlt AJ 4 S5 Ar. 85 0(p
Contractor City Of Ft Collins Sales Tax # Are you paying taxes here or by report? Here ElReport
Sales targei d by all canlractors: Are you paying with your trust account? eyes ❑ No
Is this a residential or commercial project? 19 Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached 11 Condo/townhome (single family attached) ❑ Duplex
Cl Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar Cl Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explairyry)
Is this building 50 years of age or more? ❑ Yes It 0 If yes, you mayneed to contact Historic Pmsematlon
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you w111 need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electridan.
Subcontractors: List the company name or City ofR Col/ins license o
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:
Print Name: aJl l Signature 0 o2. Date