HomeMy WebLinkAbout6836 Timpas Dr - Applications/Water Heater - 07/07/2016From:
07/07/2016 11:19 0337 P.001
Flirt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 58o
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 O Gas Log
O Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement ❑ Roofing D Sewer Line El Photo -voltaic
17 Ventilation "ter Heater ❑ Water Line O 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 #__ eLleD,3810 Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
rl �•)•�LG I ; „, r�ca�. .n�ra- C' ni ti i �r� ��_$t1`,��, � L� ti -, � �,�i3 �
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State Zip Phone cV1 D
Contractor Address City/State Zip Phone G'70
Q 1 u m �►Lh IR o ab i it) Y 1 d Lv roe
Contractor City of Ft. Collins SAt4 Tax # Are you paying taxes here or by report? 0 Here O Report
Sales tar number is required by allcon&actols Are you paying with your trust account? i5f Yes ❑ No
Is this a residential & commercial project? MIR—esidential ❑ Commercial
If residential, is it: 'atinile Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: l7 Bank ❑ Bar El Church D Hotel/Motel ❑ Medical office D Office ❑ Retail
O.•Restaurant ❑ Other (explain)
Is this building 50 years of age.or more? E3 Yes o dyes, youmayneedto cnntactHislnricPreservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 3975, you will need an,asbestos assessment to submit with this appliration.
Description of work' -
*If lawn sprinkler/backftow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the. company name or ally of Ft Collins license
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: l
Print Name ► S -rP�f`� Signatur��c Date