HomeMy WebLinkAbout3527 Copper Spring Dr - Applications/Water Heater - 02/12/2016FED/12/2016/FRI 11:45 AM
FAX No, P, 002/002
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City of
F`Qrt 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
El Demolition (interior non-structural) ❑ Electrical Alteration (not service change) I-] Gas Lighter Q Gas Log
❑ Heating Unit Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ 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.
Application # (0(K) Date
For office use only
lob Site Address (requlred) '
Value of ConstruCtion (labor, materials, profit)
Property Owner Name J Address Clty/Mate Zip Phone
A as a 4— q - - 1441
Applicant Name Address City/State ZIP Phone
J tome at be 6Vj -&qZ,
Contractor Address City/State zip Phone
a%rac�o ka G _ �irlic "Pid ' S� f12 WO
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Ef Here ❑ Report
Sales tax nr ' q ' dbyall con"ctors Are you paying with your trust account? loiYes ❑ No
Is this a residential or commercial project? 1E Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) 0 Garage
If commerdal, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explai ryp)
Is this building 50 years of age or more? ❑ Yes 1YNo If yes, you may need to contact Historic Preservaftn
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 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 companyname or Clty of Ft collins 11cense #
Electrician 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 Nam
Signature
Date