HomeMy WebLinkAbout815 Napa Valley Dr - Applications/Water Heater - 12/14/2015DEC/14/2015AMON 01:11 PM FAX No. P•003/003
N City of Planning, Development & Transportation Collins81 N. College Ave P,O, Box 58o
,For} ` °s 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
Cl Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating unit P Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing Q Sewer Line ❑ Photo -voltaic
❑ Ventilation 19 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.
!�,pplieekion a< Z�2-2-- udW
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
4115 16m ty. e WV1 526 61 64.29
Property Owner Name I Address ITCity/State Zip Phone
Applicant Name Address City/State Zip Phone
vase 415 o u1 _62.
Contractor J Address city/state Zip Phone
&IOC4410 i G i vie f7 * 9 S 06
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? eHere ❑ Report
salestax n ¢er aqbyal, conaactws Are you paying with your trust account? IdYes 11 No
Is this a residential or Commercial project? 'K Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) Ci Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
o r%tlSldU1d11L u utner texplai%ry'9
Is this building SO years of age or.more? ❑ Yes 26 If yes, you may need to contact Hlslnrlc Presetvatlon
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 rrith this application.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Pt Collins license ,#
Electrician Plumber Mechanical- Reofer
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 containers hr+rPin and elty nrrlinanccc and ctato lawn regulating building con5b uLUvi i. I kliuw that a
permit is not valid until it has been paid and Issued.
Applicant:
Print Flame: lmtbliffSignature Date