HomeMy WebLinkAbout3509 Copper Spring Dr - Applications/Water Heater - 02/22/2016From
02/22/2016 10:56 #303 P.002
FCity of
&t 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
17 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
El Ventilation ❑ Water Heater Ci Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and-e
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # b 1( 0 Q 0
For office use only
Date >
LJob(Site Address (required) Value of Construction (labor, materials, profits
Property Owner Name;:; JAddress City/State Zip Phone
Applicant Name Address City/State Zip
I -, Y Phone `� o
_
Contractor Address City/State Zip Phone G_70
i u min Y1/1 a o1.D I I;J+h C4
Contractor City of Ft. Collins S61A Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number isrequlredbyall contradws Are you paying with your trust account? J'Yes ❑ No
t-iI _f)
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: mangle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel C] Medical office ❑Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes "o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you wi/f need an asbestos assessment to submit with this application.
D- 3tz spa ►��. i
*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 H Collins license #
Electrician Plumber Mechanical Roofer Other
1 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: 1�
Print NameSignatur� ems, a�Date