HomeMy WebLinkAbout3029 Ross Dr - Applications/Water Heater - 08/04/2015AUG/04/2015/TUE 09:31 AM FAX No. P,002/002
Q— City of Planning, development & Transportation
281 N. College Ave P.O. Box 580
�„ 5rt Coalins Fort Collins, CO 80524
tooPhone970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
.,w+ This application is to be used to apply for the following permits only (check all that apply), ❑ Air Conditioning
::I: ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ,0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 9 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 # 1S4S �Z Date `6'Ll — (-S
For 0ffl0.° use only
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State ZIP Phone
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Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
&Ioraallo 1ka G I' a �Pi�l * Z fl g5 D&
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
5alestax n;ltigq by all mntradors Are you paying with your trust account? l°1Yes JJ No
Is this a residential or commercial project? '9 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 CI Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explaV
Is this building 50 years of age or more? ❑ Yes UrNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will 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 electrician.
Subcontractors: List the campanyname orCity ofFtColllnslirense#
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: Jr Ar
Print Name: fJ i Signature ,ze ,P/;?_ Date