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HomeMy WebLinkAbout1419 Sioux Blvd - Applications/Water Heater - 07/11/2016JUL/07/2016/THU 03:36 PM FAX No, P,002 FCity of lirt Collins Planning, Development & 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 ba 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 )0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic * Ventilation $ 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 # b 1 (00-3e5(� Date -7' 11— l6 For office use only lob Site Address (requlred) Property Owner Name Address Applicant Name Address Address. Contractor City of Ft. Collins Sales Tax # Sales tax n�d by all con"ctors 0 Value of Construction (labor, materials, profit) t icy/brace zip Phone as a e— n0, LA • ?:,, City/State Zip Phone low City/State Zip Phone Are you paying taxes here or by report? Here ❑ Report Are you paying with your trust account? Dyes ❑ No Is this a residential or commercial project? 16 Residential 13 Commercial If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel A Medical office 0 office © Retail ❑ Restaurant p Other (expfairyry) Is this building SO years of age or more? Cl Yes I]rNo If yas, you may need to contact .Hlstvr/c preservation If this is for a demolition permit, what year was the building constructed? Ifprior: to 1975, you wf/I need an asbestos assessment to submit with this applicatior7. Description of work *If lawn sprinkler/backflow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician, Subcontractors: List the company name or City of Ft Collins 11cen5@ g ElectriClan __ 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 NamSignature ..Gj Date �D