HomeMy WebLinkAbout3744 Sandy Shore Ln - Applications/Water Heater - 07/27/2015JUi,/27/2015/MON 01:32 PM FAX No, P, 005
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) Cl Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit %D Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 91Nater Heater ❑ Water Line Q 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 # 3 1505 �? 7
For office use only
Job Site Address- (required)
Property Owner Narit Address
Applicant Name Address
Address
Contractor City of Ft. Collins Sales Tax #
Sa/es tax rr4qby all contractors
25
C
Date 7-z-;;,- r5
Value of Construction (labor, materials, profit)
City/State Zip Phone
OrIi94+Q. as 426 -0, 9-10- 2l'b!g
City/State Zip Phone
e10VJ Ve&._ GNP- 32
City/State Zip Phone
G, AZ �s2oC�
Are you paying taxes here or by report? EiHere ❑ Report
Are you paying with your trust account? L�Yes ❑ No
Is this a residential or commercial project? 16 Residential ❑ Commercial
If residential, is it. ❑ Single Family Detached ❑ Condo/townhome (single family attached) Cl Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank 0 Bar ❑ Church ❑ Hotel/Motel ❑ Medical ofFce ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explaiqq)
Is this building 50 years of age or more? ❑ Yes IVNo If yes, youmayneedto contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpn'or to 1975, You wl//need ran ashoctnc accaevnonf t6 rwL nli w1th rhi?
Description of work
*If lawn eprinldcr/backnuw V1 CVCIIICI, uius: use ucenseo plumoer. It tirst-time A/C, must list licensed electrician.
Subcontractors: Use the company name or, City of Ft Cblllns 1/tense #
Electrician Plumber Mechanical Roofer Other
I
i nereny 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.
Applicants Print Name: tJfi t - Signature .4v� pate b-6