HomeMy WebLinkAbout900 Driftwood Dr - Applications/Water Heater - 05/28/2017From
05/31/2017 09 34 0620 P 003/003
1119y,-r.-x
Fort of
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 tmpe used to apply for the following permits only (check all that apply). ❑ Air Conditioning
O 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 ISeNater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application.
Application #_bl-40
99
For offlw Lise only
Incomplete applications will not be accepted
Date
Sob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Saks tax namberis MgL*esby a0 avoamm
Are you Paying taxes here or by report? I tHere 411eport
Are you paying wr your trust aceount7 XYes q No
Is this a residential or commercial pro)ect7 XWkesidential 0 Commercial
If residential, Is it: E3 Single Family Detache& ❑ Condo/bownhome (single family attached) O Duplex
13 Multifamily (apartment) ❑ Garage
If commercial, Is It: E3 Bank E3 Bar O Church ❑ Hotel/Motel ❑ Medical office 13 Office ❑ Retail
O Restaurant O Other (explain)
Is this building SO years of age or more? O Yes O No If yes; you may need to contact HkgV C Avserientfo r
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, you KY// need an astestus assessment to submit with tlus applIcaam
Description of
*If lawn spnnkler/baddtow preventer, must fist licensed plumber If first-time A/C, must list sad da
Subeontradbors: LLst the company name or Gty of tb/hrs fic mw A �r
Elecblaan Plumber Mechanical Roofer__ coleK
Q
I hereby acknowledge that I have read this application and state that the above Information is complete a act. 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 0 4 Date
Name. 51 � 11GA�Q ��� Q��•+_•• nature . �a .� . ��—