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HomeMy WebLinkAbout518 Sand Dollar Ct - Applications/Water Heater - 11/14/2016NOV/10/2016/THU 08:38 AM FAX No, P.005 Fart Collins .. Planning, Development & Transportation 281 N. College Ave P.O, Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVEN -THE -COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). ❑ Air CondJtioning 0 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 VWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer), Complete all applicable information on the application. Incomplete applicat1io s will not be accepted, Application # J J 1 � �J � Wn Date I I L� U► For al9`Ice use only Job Site Address (required) Value of Construction (labor, materials, profit) k 86� 1 lzb6 l z ?) Property owner Name Address City/State Zip Phone Applicant Name Address City/State zip Phone Contractor Address City/State Zip Phone dKta Sk*kebi� Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report 5alestax number isrequ/redbyall contractors. biCO$��P _,— Are you paying with your trust account? ❑ Yes li No Is this a residential or commercial project? LPIResidential [I Commercial If residential, Is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex El Multifamily (apartment) Q Garage If commercial, is it., ❑ Bank Q Bar © Church Q Hotel/Motel Q Medical office Q Office 13 Retail ❑ Restaurant ❑ Other (explai Is this building 5o years of age or more? ❑ Yes NrNQ ,If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? Ifprior to 1975, you will need an asbestos assessment to submit with this application. DescriDtion of workTftka.•a,'_ ,,•..ly aW•.+' rid& s 0 *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Llst the company name or Clty 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, x know that a permit is not valid until It has been paid and Issued. Applicant: !! j Print Namec c:� m la� signature OAIJ- E�Gt-eef Date 11 jr-1 I I to