HomeMy WebLinkAbout3832 Little Dipper Dr - Applications/Water Heater - 02/25/2016From 9702299983 1.970.229.9983 Thu Feb 25 10:23:21 2016 MST Page 3 of 3
FROM : FAX NO. :
Feb. 25 2017 05:21PM P3i3
Ci Of
F IN Collins
Planning, Development a Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMIT'S 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 (riot service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing Cl Sewer Line ❑ Photo -voltaic
❑ Ventilations Water Heater Cl Water Line ❑ Wood/Pellet Stove (must be CPA certified, provide make, model and
manufacturer
Complete all applicable information on the application. Incomplete applications will not be accepted. (p
Application # Date �- - D,.� `t (,P -
ivr office Use Only
Job site Address (requlred)
3832 LITTLE DIPPER DR
Property Owner Name Address
CRYSTAL NEAL 3832 LITTLE
Applicant Name Address
Contractor Address
to
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all wntradOfY
('a a
Value of Construction (labor, materials, profit)
City/State Zip Phone
city/state zip Phone
City/State P- (Wky-kQ1p Phone ci"'Ib'
Are you paying taxes here or by report? boere ❑ Report
Are you paying with your trust account? es ❑ No
Is this a residential or commercial project? Z Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condoltownhome (single family attached) El Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
d Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes zTiio if yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was tfie building constructed? _........_—
If ptior to 1975, you will need an asbestos assessment to submit with this appllcatlon.
Description of work ...
REPLACE WATER HEATER
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Oty of At Collins license ,#
rlectriclan 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. t
Applicant:
Print Name. 1f n
Date — � A