HomeMy WebLinkAbout1707 Constitution Ct - Applications/Water Heater - 11/21/2017Fortn Planning, Development, & Transportation Services
Collins Communily Development & Neighborhood Services
rz 281 North Co lege Avenue
Fort Collins, GO 80524 Main 970 416.2740 Fax 970 224 6134
OVER -THE -COL
This application is to be used to apply for the foil I t
❑ Demolition (interior non-structural) ❑ Electrical Alter
❑ Heating Unillo ❑ Lawn Sprinkler ❑ Mobile Home rel
❑ Ventilation A Water Heater ❑ Water Line ❑ W (
manufacturer
Complete all applicable information on the applic ti
Application #
For office use only
Job Site Address (required)
t 70-1
Pr a Ow er N e Address
�A�
ARphcant Name Address
\j Address
Contractor City of Ft. Collins ales Ta)
Sales tar number rs required by all contractors.
NTER PERMITS ONLY
Ing permits only (check all that apply). ❑ Air Conditioning
ition (not service change) ❑ Gas Lighter ❑ Gas Log
acement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
'Pellet Stove (must be EPA certified, provide make, model and
Incomplete applications will not be accepted
Date 6t121
�P3 - a
Value of Construction (labor, materials, profit)
(0g9,W
City/State Zip Phone
%_;cYletaAe r , Zip Phone
IJ/�/ i w c ��2- 6Jr
n ty/ tate ZIP Phone
Are you ing taxes here or by report- �1�i ere ❑ Report
Are you paying with your trust account; d Yes ❑ No
Is this a residential or commercial project'2 esidenti Il ❑ Commercial
If residential, is it: jJ�Ingle 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 morel ❑ Yes ❑ No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the bui ding constructed?
Description of
*If lawn spnnkler/backflow preventer, must list licensed pl
Subcontractors: Lrs7 the company name or City of Ft Co%
Electrician Plumber p
I hereby acknowledge that I have read this application and
comply with all requirements contained herein and city ordi
permit is not valid until it has been paid and issued.
Applicant:
Print Name,
Revislon date 2f62017
fer. If first-time A/C, must list licensed electrician.
license #
Roofer Other
that the above Informabon is complete and correct I agree to
s and state laws regulating building construction I know that a
Date J(I Z ( !