HomeMy WebLinkAbout1713 Brentford Ln - Applications/Water Heater - 12/11/2015Planning, Development & Transportation
City Of 281 N. College Ave P.O. Box 580
F�rt Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
F5 7
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
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation M 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 #,
For office use only
Date JJ-1 1 -15
4'27co
Job Site Address (required)
Value of Construction (labor, materials, profit)
�
r 1.
90 -7Q
Property Owner Name Address
City/State Zip
Phone
CCU 5U
h0 , - P7
Applicant Name Address
City/State Zip
Phone
0 CA, 98
Pierce.0
- 0774
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? 12
If residential, is it: IN Single Family Detached
❑ Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Chun
Residential ❑ Commercial
❑ Condo/townhome (single family attached)
❑ Garage
h ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes M No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior 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 company name or City of Ft Collins license #
Electrician Plumber/'IF —ni 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: I 1 17 d� �L� �� �d-1u 5
Print Name: r<y� P,r` W Signature ,21A/` Date