HomeMy WebLinkAbout1557 Corydalis Ct - Applications/Water Heater - 11/27/2017Planning, De
Fort Collins Commun
281 North C
Fort Collins,
OVER -THE -CO
This application Is to be used to apply for the folli
❑ Demolition (interior non-structural) ❑ Electrical Ali
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home i
❑ Ventilation Water Heater ❑ Water Line ❑ We
manufacturer
Complete all applicable information on the applic
Application V,otSq)
For office use only
,lopment, & Transportation Services
Development & Neighborhood Services
ge Avenue
80524 Main 970 416.2740 Fax. 970.224.6134
i
I
INTER PERMITS ONLY
Ong permits only (check all that apply). ❑ Air Conditioning
ration (not service change) ❑ Gas Lighter ❑ Gas Log
placement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
d/Pellet Stove (must be EPA certified, provide make, model and
Incomplete applications will not be accepted. i
Date
i
Job Site Address (required)
Value of Construction (labor, materials, profit)
/
Property Owner Name Address
City/State Tip Phone
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Applicant Name a
j City/State Zip Phone
�jAddress j�
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Contractor ~" Address
City/State,Zip Phone
t..f`..dro 'a i,.1 ..6i i•f I:i..F f. LL.., F _ t l �
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?,' LHere Cl Report
Sales tarnumber ismquiredbyall contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? l(11yResiden
al ❑ Commercial
If residential, is it. ®Single Family Detached ❑ Cc
ndo/townhome (single family attached) ❑ Duplex
Id MulbMmily (apartment) ❑ Gi
rage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ H
el/Motel ❑ Medical office ❑ Office ❑ Retail i
❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? 0Yes13Nc
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
r� a
*If lawn sprinkler/bacldiow preventer, must list licensed plumber.
If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orQtyofFtCol/i
7s license# '
Electrician Plumber Mechanical
Roofer Other
I hereby acknowledge that I have read this applirabon 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 regulabng building construction. I know that a
permit is not valid until it has been paid and issued.
ry
Applicant j 1, , , r
a �) % i_ 7
Print Name: ,�'., i' ' } (.ld � it: 'ti Signatu
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RevL m date 2MMV
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