HomeMy WebLinkAbout403 Strasburg Dr - Applications/Water Heater - 01/13/2016JAN/12/2016/TUE 04:01 PM PAX No, P,002/002
City of Planning, Development & Transportation
1^ 281 N. College Ave P.D. Box 580
N � ` CoLLIns Fort Collins, CO 80524
�. Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
xThis application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) 13 Electrical Alteration (not service change). ❑ Gas Lighter Q Gas Log
❑ Heating Unit )' Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing Q Sewer Line ❑ Photo -voltaic
❑ Ventilation Ili Water 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 # E)I (oDDl -:—�?9 Date 3 1
Far offlre use only
Job Site Address (required) Value of Construction (labor, materials, profit)
W a u IN- For 0611iywgi, CO 10525 35%si%
Property Owner Name Address City/State Zip Phone
AMC as 4 0. '►- 5
Appllc nt Name Address City/State Zip Phone
tm.c a g `o VJ - 60
Contractor Address Gty/State Zip Phone
&Iaglao }a i G E lirlt A >AZ gSJ3A
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Ef Here ❑ Report
sales raxrlyrp¢er j gyyedbyadmnbadorA Are you paying with your trust account? OdYes ❑ No
Is this a residential or commercial project? 16 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 ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explaiqj)
Is this building 50 years of age or more? ❑ Yes &No if yes, you may need to contactHistonc Preseruat/on
If this Is for a demolition permit, what year was the building constructed?
!f prior to 1975, you will need an asbestos assessment to submit r^nth b /s 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 G'ty of Ft Collins license g
Electridan 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: �J�1 t Signature Date )2 iV