HomeMy WebLinkAbout1800 Jamison Ct - Applications/Water Heater - 07/12/2017City I Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins,
CO 80524
Phone 970-41616-27402740 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 ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)
Complete all applicable information on the application.
Application # � J a[ S —
For office use only
Incomplete applications will not be accepted
Date 7 ` /.�L — / �?
Job Site Address (required)
Value of Construction (labor, materials, profit)
/800 ��MISon/ Cr
q 37 c9-�- -
Property Owner Name Address
City/State Zip Phone
ev �eoln /P,O J-4
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Applicant Name Address
City/State Zip Phone
0 75
C-'el�nlG� 3o8_q7F6
Contractor Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?AgQiere l;] Report
Sales tar number is required by all contractols 03
Are you paying with your trust account? ❑ Yes E�INo
Is this a residential or commercial project? `.Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
iffMultifamily (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 HisloncPfeservabon
If this is for a demolition permit, what year was the building constructed?
Ifpnor 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 the company namee or City of Ft Collins license #
Electnaan Plumber `�' 7 3 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 r sting building construction I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print NamSignature Date