HomeMy WebLinkAbout542 Larkbunting Dr - Applications/Water Heater - 08/16/2017City of Planning, Development, & Transportation Services
Fort Collins J 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 x`
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 lJnrt ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation JI Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer) 1 - ' - • I 1 11 ` , - ` ' -
Complete all applicable information on the application Incomplete applications will not be accepted
�. IOgys
__Application # -Date
For office use only =
Job Site Address (regarredJ Value of Construction (labor, materials, profit)
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5 2 611i7 IM or4
Property Owner Name - Address City/State Zip Phone
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Applicant Name Address /State . Zip, Phone
Contractor Address-- City/State Zip Phone
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Contractor City of Ft. Ilins' Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number Is required by all mnbactors ' . Are you paying with,your trust account? ❑ Yes ❑ No
Is this a residential or commercial prolect7 ❑ Residential ❑ Commercial
If residential, is it Mingle 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 So years of age or morel ❑ Yes ❑ No If yes, you may need to contact Hlstonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work W a-kr hea er I r e4la(c r»yn tgo -. ) CLt l o n , 36 , bou 311.4
*If lawn spnnkier/backflow preventer, must list licensed plumber.' If first -time -A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of Ft Collins license #
Electrician Plumber 10h ariM Mechanical Roofer Outer
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: n
Applicant -
Print
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Print Name 1Giy!/ (�'iww lez Signature Date
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Rev = date vsrzon