HomeMy WebLinkAbout2930 W Stuart St - Applications/Water Heater - 01/15/2016JAN/15/2016/FRI 12:13 PM FAX No. P.002/002
r City f Planning, Development & Transportation
Collins1 N. College Ave P.O, Box 580
r F61 {, 1, h, Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
x This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) E3 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas -Log
❑ Heating Unit Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 14 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 # 61 LO 000L L+ Date
For office use only
]ob 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 Nprnc AU0 ass 41ty/azare• Lip Phone
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Contractor j Address City/State Zip Phone
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Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
Sa/Vs tax Mfiqyred by all contractors Are you paying with your trust account? R(Yes ❑ No
Is this a residential or commercial project? 19 Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) CI Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel C] Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explairyry)
Is this building 50 years of age or more? ❑ Yes 3rNo If yes, you may need to contact HlstaHc Preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to Z975, you w1/1 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 eiectriclan,
Subcontractors: Ust the company name or City of a Coollins license #
Sectridan 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: I'
Print Name:_"blil naM6 Signature Date S t