HomeMy WebLinkAbout5125 Sawgrass Ct - Applications/Water Heater - 08/23/2016N, Collins
Planning, Developrnent & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
1JE 72E_CCINT 4). FERMI T OILY
Tills 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 Water Heater ElWater Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)
COLiiplate all applicable ormaation onththe
�application. Incomplete appiicattiions will not be accepted.
,'Application # � �\P0 Jam'" �- Date o'a+3'l fP
Fnr nftrra use onlV
fob Site Add = (r�7u/redJ 'ilalua of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
A)plicantName- Address
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City/State Zip
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Phone
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Contractor Address
City/state Zip
Phone
#99,
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Contractor- City of Ft. Collins Sales Tax
Are you paying taxes here or by report? ❑Hera `?�(Report
number isrequiraibyOff contractom
Are you paying with your trust account? 'Wes
❑ No
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Is this a I-esidential orcommet.dal protect? .Residential ❑ Commercial
If residential, Is It' Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
/❑ ImUltifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
17 Restaurant 13 Other (explain)
Is this building so years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contactHlstorlc Preseruatlon
If this is for a demolition permit, what year was the building constructed?
ifpliol' to 1975, you P14111 qVd an asbestos assessment to submit with 65is application.
Description of work ' "1
*IF lawn sprinkler/backflow preventer, must list licensed plumber. IF first-time A/C, must list licensed electrician.
Subcontractors., List Me cnmpanyname crC4Y0"tCoi/inslicanse #
Liedridan Plumber Mechanical Rooter 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 buliding construction. I know that a.
permit is not valid until It has been paid and issued.
Applicant: 7'V y _ p9- �,F� �(
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Print Mam Signature / ate _ �3 4