HomeMy WebLinkAbout7120 Strasburg Dr - Applications/Water Heater - 04/17/2017City of Planning, Development, & Transportation Services
F,r t Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
47
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 ❑ Water 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 # 45 1 riQ 10 7;)�
For office use only
Date �7. / 7
Job Site address (required) Value of Construction (labor, materials, profit)
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Property Oyvner Name Akrss City/State Zip Phone
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Applicant Name / Address City/State Zip Phone
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Contractor Address City/Stat Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here @=Report
Salesr number is rep iedb # cMrs. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: 24 Single 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?
Description of work s_J
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List die company name or Gty of Ft Collins license 6'
Electrician Plumber--/ Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the abo a information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and scat a s regulating building construction. I know that a
permit is not valid until it/haass been pAt—
aid and issued. /
Pent Name:?A'lii, ✓Cj Signature Date — 1
Revision date 2r.2017