HomeMy WebLinkAbout1606 N College Ave - Applications/Water Heater - 11/27/2017Planning, Dev Opment, & Transportation Services
F_ &t Collins Community Development & Neighborhood Services
281 North Colle ge Avenue
Fort Collins, CC 1 80524 Main 970.416 2740 Fax. 970.224.6134
OVER -THE -CC
This application is to be used to apply for the fol
❑ Demolition (interior non-structural) ❑ Electrical A
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home
❑ Ventilation Water Heater ❑ Water Line ❑ W
manufacture
Complete all applicable information on the appiii
Application # 18 `-1�) -1l0i 5-1
For office use only
NTER PERMITS ONLY
ing permits only (check all that apply). ❑ Alr Conditioning
ition (not service change) ❑ Gas Lighter ❑ Gas Log
lacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
/Pellet Stove (must be EPA certified, provide make, model and
on. Incomplete applications will not be accepted
Date �\ " 21, 1
Job Site Address (requited)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip Phone
Ic�� v �1
, cue 1. — �. 2-0/
Applicant Name Address
/+ p
V'-Y- � y
f/State Zip Phone
� Pa�f r�
% I i�-�r-1 i(f, I (R,i
Contractor Address
Sty/State Zip Phone
Contractor Oty of Ft. Collins Sales Tax #�'J
Are you paying taxes here or by report? I7Here ❑Report
Sales Wnumber Isrequrredbyall contractors
Are you paying with your trust account/0 Yes ❑ No
Is this a residential or commercial project? JEMesident
If residential, is it: ❑ Single Family Detached ❑ Cc
el ❑Commercial
ndo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Gz
rage
If commercial is it: ❑ Bank ❑ Bar ❑ Church ❑ H
t el/Motel D Medical office ❑ Office ❑ Retail
❑ Restaurant Q�Other (explain
tl %!L921i J
Is this building 50 years of age or more? ❑ Yes 0 No;
If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the bi
ilding constructed>
Description of work u
' ' P! 7-7
*If lawn spnnkler/backflow preventer, must list licensed plu
nber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or Clty of Ft Colli
s 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 Im i9 atu
Date ' I
--
t
Revivon date 216r2017