HomeMy WebLinkAbout1913 Meadowview Ct - Applications/Water Heater - 12/18/2017From
12/18/2017 09.26 #642 P 002/003
Ftyof Planning, Development, & Transportation Services
ort Cottins 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
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 O Sewer Line O Photo -voltaic
❑ ventilation `Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted
Application #_ 17 110 0 ) Date Ia"V7 1
For ofte use only
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
`log- 01.lg
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Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Co ins Sales Tax # Are you paying taxes here or by report? %Here ❑ Report
Sales tax numberis/equnabyall connaaa—, Are you paying with your trust account? VPYes ❑ No
3Z�ns
Is this a residential or commercial project? UResidential ❑ Commercial
If residential, is it: Ingle Family Detached ❑ m Condo/townhoe (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 O No If yes, )nu may need to contact Historic Preservabon
If this is for a demolition permit, what year was the building constructsd7
Description of wof�
*If lawn sprinkler/baddtow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: list die company name or City of R Collins Arerise 0
Electrician Plumber Mechankal 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: �caQ Signature �Q�� Date
w.1000 date 2MMI7
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