HomeMy WebLinkAbout2230 Silver Trails Dr - Applications/Water Heater - 10/12/2016OCT/11/2016/TUE 09:09 AM FAX No, P,004
47&107
Fort Collins
/11-� -
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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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 tighter Q Gas Log
0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement d Roofing a Sewer Line 0 Photo -voltaic
❑ Ventilation Water Heater ❑ Water Line 0 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 # I V� I i j bate j, ,
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For office use only
1 �
Job Site Address (required) Value of Construction (labor, materials, profit)
2 Z O A w ��ta.1� Dr. T-00f Cn11in C�0 d�2Zc L 'i'l �;
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State ZIP Phone
I WILD i' bt1r i 8 olc 2-15Z
Contractor Address
City/State Zip. Phone
Contractor City of Ft, Collins Sales Tax # Sales lax nuAre you paying taxes here or by report? ❑Here ❑Report.
b b i5 requ/red by contractors Are you paying with your trust account? ❑ Yes 0 No
Is this a residential or commercial project? eResidential d Commercial
If residential, Is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) . q Garage
If commercial, Is it: ❑.Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 13 Office ❑ Retail
❑ Restaurant ❑ Other (explai
IS this building 50 years of age or More? ❑Yes No Ifyw, y,vumay need to contactHistonc Preservation
If this is fora demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
*If lawn sprinklerJbackflow preventer, must list licensed plumber. If first-time MC, must list licensed electrician.
Subcontractors; List the company nafie or City 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;
Print Name: 56M— i f —Signature Date jC? ! 1 l (p