HomeMy WebLinkAbout5207 Trappers Creek Ct - Applications/Water Heater - 11/16/2016-Pott 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 Horne replacement ❑ Roofing ❑ Sewer Line r Photo -voltaic
❑ Ventilation ❑ Water Heater X 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 '# �I �o�(J���!y Date I OR)
For of ice use only
Job Site Address (rewired)
Value of Construction (labor, materials, profit)
Property Owner ame
Address
J City/State Zip
Phone
5
i i;
Sri '+ C2-\ ,;P,
Name
'`
Address
City/State Zip
Phone
rplicant
lrl-�. 1, / 1 .1
X ; , �'i .1.1 �'
godractor ,,t
'I
ddlress
City/State, Zip
Phone
�l
�f h+1f(•, 1��,.')
I Cont actor City of Ft. Collins Sales
Tax
'�?
iv
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is requirea by.3ll C.ontracrors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: _0'Slnole 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? 0 Yes I No If yes, you may need to contact Historic Presenlation
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List lire company name or City of Ft Collins license m
Electrician.__....._.._. Plumber -E�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: ^�, iSignature Name:—KE'. E_--`--- /
Date
—