HomeMy WebLinkAbout2421 Treestead Rd - Applications/Water Heater - 11/28/2017 (2)City of Planning, Development & Transportation
281 N College Ave P 0 Box 580
Forrr�'} ` Collins Fort Collins, CO 80524
Phone 970-416-2740 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 )!!I�1Qiater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)
Complete all applicable information on the application. Incomplete applications willnotbe accepted
Application # 9 1-10 iilb3q Date
For offce use only 1 110 W)M
Job Site Address (required) �- ` Value of Construction (labor, m tenals, profit)
i2ee � °
5
3o 76
1 s 31. &a
Property Owner Name Address
City/State Zip
Phone
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S IkA t f%D
23 ifs
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/state Zip
s C� 052,11
Phone
Zzs z28Z
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales lax number Xri zredbyall contractors
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Are you paying with your trust account? Yes ❑ No
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Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is itSwagle 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 mayneed to contactHistonc Preservation
If this is for a demolition permit, what year was the building constructed?
If poor to 1975, you will need an asbestos assessment to submit with bits 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 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.
Applicant:
Print Name A441 A I h Signature 1AA Date O