HomeMy WebLinkAbout1700 Briargate Ct - Applications/Water Heater - 07/11/2016JUL-06-2016 03:42PM FROM -
0704848364 T-578 P.014/017 F-020
Fart Collins
Planning, Development 8t Transportation
281 N. College Ave P.O. Box 580
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 ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation JKWater 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 # 814638 93 Date
For ofte use only .
Job Site Address (&puireid)
Value of Construction (labor, materials, profit)
CT
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� 137�
Property Owner Name Address
City/State Zip
Phone(llq__`iC%
i-100�~
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Applicant Name Address
City/State Zip
Phone
5
305-3479
Contractor Address
City/State Zip
Phone
Fort Collins Heating and Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970
484-4552
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
❑ Report
Se m bwnumdwkrmuired byall wn&adors;
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? JKResidential C7 Commercial
If residential, is It: JIM Single Family Detached i7 Condo/townhome (single family attached) ❑ Duplex
O Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church 0 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes A No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prier io 1975, yrou will need an asbeslns assessment ro submit with this application.
Description of work
*If lawn sprinider/baMow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname or Py off Collins rcense 0
Electrician Plumber Mechanical 141309 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: Angola Morrow _ Signature Date