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Community Development & Neighborhood Services
City ®f 281 N. College Ave Fort Collins, CO 80,522
1
Fort Collins 970.221.6760 970.224.6134 -fax
Building Permit #: B1601843
Issued Full: 04/11/2016
Permit Type: Residential Water Heater
Site Address: 5208 BLACK BARK CT
Job Valuation: $1,575.00 Category: Residential
Owner: KEAHEY SEAN M
5208 BLACK BARK CT
FORT COLLINS, CO 80528 Phone: 970-226-4942
Zoning: Front setback: Rear setback: Right setback: Left setback:
Minor Amend #: Plat File #: ZBA Case #:
Zoning district: LMN - LOW DENSITY MIXED -USE NEIGHBORHOOD DISTRICT
Legal: Subdivision/PUD:
Filing #: Lot #: Block #:
Code: Res sq ft: Com sq ft: Ind sq ft: Basement sq ft:
# of stories: Occ Group: Const Type:
Fire Sprklr: Stock plan #: Stock plan options:
Contractor: License #: Supervisor cert #:
Phone:
Subcontractor(s-) Phone License Number
Mechanical: NORTHERN COLORADO AIR INC 970-223-8873 H-837
Work Description: Replace water heater
I SCHEDULE INSPECTIONS: *** By Phone: 970-221-6769 *** By Web: http://www.fcgov.com/CitizenAccess
***By Mobile Device: http://www.fcgov.com/CitizenAccess/mobile
Inspections: FNP FNE FNIVI
TOTAL FEES PAID AS OF 04/11/16: $60.44 Payment method: Trust Account
** Fee Detail Displayed on Next Page
As a condition for the issuance of a permit, I hereby declare that I am the owner or owners agent, authorized to perfomi the proposed work on the properly described herein.
I agree to comply with all the requirements contained herein, and City ordinances, and State laws associated with such work. I understand that such permit may be
revoked in the event that issuance was based on incorrect information. This permit shall become null and void if the work authorized by such permit is not commenced,
suspended, abandoned or not inspected within 180 days from the date of such permit.
Carbon Monoxide Alarm required within 15 feet of each bedroom entrance.
Signature: Print Name:
Date:
Form Revised Oct
` I '' Community Development & Neighborhood Services
City of 281 N. College Ave Fort Collins, CO 80522
Fort Collins 970.221.6760 970.22¢.6134 -fax
I .
Building Permit #: B1601843
Issued Full: 04/11/2016
I Permit Type: Residential Water Heater
Site Address: 5208 BLACK BARK CT
Job Valuation: $1,575.00 Category: Residential
Transactions
Method Check Number Date Paid
Amount Paid
Comments
Trust Account 04/11/2016
$60.44
Receipt issued: 04/11/2016 Total Paid to Date:
$60.44
Fee Description Account Code
Fee Amount
Amount Paid
City Sales/Use Tax 251.122030
$30.32
$30.32
County Sales/Use Tax 100.217030
$5.12
$5.12
Permit Flat Fee w/o Subs $25 1000.422010
$25.00
$25.00
TOTAL FEES:
$60.44 $60.44
Date Paid
Amount Due
04/11/2016
$0.00
04/11/2016
$0.00
04/11/2016
$0.00
$0.00
$0.00
Fee Amounts are valid for date of this document only. Fees subject to change without notice.