HomeMy WebLinkAbout4324 Pearlgate Ct - Applications/Water Heater - 08/05/2016AUG/05/2016/FRI 03:25 PM
FAX No,
P. 003
Flirt Collins
/111'�
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort collies, 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
d ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas lighter ❑ Gas Log
❑ Heating Unit 4 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
�.. Q Ventilation Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
�. manufacturer).
Complete all applicable informatio Z a application. Incomplete applications will not be accepted.
iApplication # �J l0Data
For oftice use only
Is this a residential or commercial project? UResidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If Commercial, is it: CI Bank 0 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? ❑ Yes CrNo Ifyes, you may neeo'to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
if pr1or to .t 975, you will need an asbestos assessment to submit plith th/s application.
Description of work
*If lawn sprinkler/backilow preventer, must list licensed plumber: If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or City of Ft Collins 11cense 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. I know that a
permit is not valid until It has been paid and issued.
Applicant:
Print Name: _ Signature Date C- I LP