HomeMy WebLinkAbout713 Larkbunting Dr - Applications/Water Heater - 06/25/2015JUN/24/2015/WED 05:57 PM FAX No, P.002/002
O City O f Planning,, Development & Transportation
281 N. College Ave P.O. sox 580
�rForR} Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
b 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
❑ Heatinq Unit )D Lawn Sprinkler ❑ Mohila Wnme replacement ❑ Roofing ❑ Sewer Line ❑ Photo-valtaiu
❑ Ventilation 11 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 # Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
o� 1%i U 14 1 Is41-7
Property Owner Name Address City/State ,Zip Phone
ia, ii05 a e- 5%1- 351a
Applicant NarRe Address Clty/State Zip Phone
Contractor Address City/stall 70 ohnnp
(wa dlJo ,Ika G Ian �i� - 55 gS2aCo
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? Ef Here ❑ Report
sales taxnlrei` q :obyall contractors Are you paying with your trust account? E(Yes ❑ No
Is this a residential or commercial project? Ff Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamlly (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ HoteVMotel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (exdairy)
Is this building 50 years of age or more? ❑ Yes Ao If yes, You mayneed to contact Historic Preservatibn
If this is for a demolition
permit.r shat yearwashebuilding con
ed smsaslced?
Aniw ru1yia, yuu r^nunananment to submit w�his _
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 license
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.: I r ti cr�,.�e,.. o _t/OnLO
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