HomeMy WebLinkAbout1906 Newcastle Ct - Applications/Water Heater - 11/02/2016Ciof
Fort 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 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 Ovater 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 #IQ(` )Q 1 n Date �l Z
For office use on/);'
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip
Phone
6VZRA Z/!Y 6vz 8aZe
70 zZ�
Applica ame Address City/Sta a Zip
?�_4 A 6111*_*' r �5 24
Phone
20 z25 22
Contractor Address City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required byall contractors. Are you paying with your trust account? ;5igl(es
❑ No
Is this a residential or commercial project? kl`Residential ❑ Commercial
If residential, is it: " ' Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If poor to 1975, you will need an asbestos assessment to submit with this application.
Description of work rTC•'G AV4,AA/ '
*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 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: A AV0147
.-PrintName:_aW \ Signature 44 Date
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