Loading...
HomeMy WebLinkAbout1335 Red Oak Ct - Applications/Water Heater - 08/10/2017City of Planning, Development, & Transportation Services F6 t Collins Community Development & Neighborhood Services 281 North College Avenue Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134 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. Incomplete applications will not be accepted. Application # �7� (o Date b For office use only Job Site Address (r quired) Value of Construction (labor, materials, profit) 133 F l o� Property Ow6er Name / p� Address Ci ty/State Zip Phone ( C�i ' [ (J S � C_ r 33 sr e-Pd ebP),P7- 90PO 1-10 )./ Applicant Name Address City/State Zip Phone n l of 6 i�YCc�p 4 L V,!,-d/ 2C 7 Contractor Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ©-Here ❑ Report Sales tax n maerisrequired byall contractors. Are you paying with your trust account? ❑ Yes ❑ No D ?AR Is this a residential or comjmercial project? Residential ❑ Commercial If residential, is it: UrSingle 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 (explai Is this building 50 years of age or more? ❑ Yes o 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 ItIf j2E,/ *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or City 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. I know that a permit is not valid until it has been paid and issued. r Applicant: �^ I Print Name: (1 ` %� z Signature Date l Revision date 2/62017