HomeMy WebLinkAbout2242 Clydesdale Dr - Applications/Water Heater - 05/23/2016Planning, Development & Transportation
281 N. College Ave P.O. Sox 580
Fort Collins, CO 80524
Phone 970-1-16-2740 Fax 224-6134
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This application is to be used to apply for the following permits only (check ail that apply). ❑ Air Conditioning
❑'Dem,olition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Ei 1-1--ating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
I Ventilation Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, modal and
rl ,anufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
1pp!i:ation ;f 1 1
Uii/?J Date
For office use only
mob Site r:cicic es� (izquii2d) Value of Construction (labor, materials, profit)
operty Owner Nam- Address City/State Zip Phone
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A)piicarit Name.. Address City/State Zip Phone
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Contractor. Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ,Report
-..;_5 t.3.% nu177berisrequired bydii<<°ntractors Are you paying with your trust account? 'NYes ❑ No
! is this a residential or commercial project? residential El Commercial
U residential, is it: `� Single Family Detach d ❑ Condo/townhome (single family attached) ❑ DUPh-'X
❑
I� MUitifarnily (apartment) Garage
Ir commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
i ❑ Restaurant ❑ Other (explain)
rs this building so years of ageor more? ❑ Yes ❑ No Ifyes, you may need to contact Historic Preservation
If this is for a deanolition p�errriit, what year was the building constructed?
Dr -prior to 1975, you ruff/ ed an asbestos assessment to submit with this application.
of work
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Description
1: lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: List the company naive or City of Ft Collins license;
L"I�ctrician__ Plumber Mechanical Roofer __._ Other -_
! f hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
with all requirements contained herein and city ordinances and state laws regulating building construction. I 1c11011i that a
Icomply
permit is not valid until p, has been paid and 'issued.
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Applicant: •
�Signature. ate
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