HomeMy WebLinkAbout2826 Zirkels Ct - Applications/Water Heater - 06/20/2016JUN/17/2016/FRI 03:30 PM FAX No, P,002/002
70 City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
r-+r„ 6rt Collins Fort Collins, CO 80524
�- phone 970 416 2740 Fax 224 6134
CJ
OVER-THE-COUNTER PERMITS ONLY
A This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
d Demolition (interior non-structural) CI Electrical Alteration (not service change) ❑ Gas Lighter Q Gas Log
❑ Heating Unit f1 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation V Water Heater 0 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 # f3lteo-35-76 Date (P /a O A (o
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner"
Address City/State Zip Phone
b tq as a a -204- 0169
Applicant Name Address City/State. zip Phone
Contractor Address City/State zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here Q Report
sales tax nv� er; y q!:!byallcan&actors Are you paying with your trust account? lWYes ❑ No
Is this a residential or commercial project? 16 Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: CI Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? ❑ Yes WNo Ifyes, you may need to contact Historic Preservation
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 appl/cation.
Description of work
*If lawn sprinkierlbackflow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or City of Ft Collins /!tense #
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 Name. �J ! Signature ..t.� Date (Q 1 IG