HomeMy WebLinkAbout721 Parkview Dr - Applications/Water Heater - 06/17/2016JUN/16/2016/THU 09:00 Aid FAX No, 11',002
City of Planning, Development & Transportation
&t *'"' 281 N. College Ave P.O. Box 580
Colhns Fort Collins, CO 80524
Phone 970-41$-2740 Fax 224-5134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Q Heating Unit J] Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line E3 Photo -voltaic
❑ Ventilation i 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 #_ILoO y� g Date Lg
For office use only
]ob Sijte Address (required) Value of Construction (labor, materials, profit)
'i 1 ParthliSul ll � r q0 25 V 1
Property Owner Name Address City/State Zip Phone
t
Applicant Name Address t_ City/State Zip Phone
I A641'tt,,,_euj `` If-fJ' tame at 610 pit.% ,_' _r
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Contractor J Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
5ales t" ITer i q d by all contractors Are you paying with your trust account? Mf Yes q No
Is this a residential or commercial project? Vf Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached 17 Condo/townhome (single family attached) ❑ Duplex
d Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank , ❑ Bar ❑ Church 4 Hotel/Motel ❑ Medical office ❑ Office ❑ Retall
❑ Restaurant ❑ Other (explai ry)
Is this building SO years of age or more? ❑ Yes Flo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpriar to 1975, you will need an asbestos assessment to submit w1th this application.
Description of work.
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Su beontractors: List the company name or City of Ft Collins license 9
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. x know that a
permit is not valid until It has been paid and issued.
Applicant: ����
Print Name: 1 Lf 5;gmature ,r" Date