HomeMy WebLinkAbout1550 Blue Spruce Dr - Applications/Water Heater - 12/27/2017City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 970 416 2740
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-voltalc
❑ 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 &IOZ
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Application #
For office use only
Date./ 2 -21 'I %
)ob Site Address (required) Value of Construction (labor, materials, profit)
nn 4 ow
Property Owner Name l� Address City/State Zip Phone
9 - -
ApplicYnt Name Address City/State Zip Phone
Daniel Ormesher
Contractor Address City/State Zip Phone
Independent Plumbing Solutions, Inc. 1611 E Lincoln Ave, Unit A FC CO 80524 970-566-1377
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ff"R�port
Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes C9'IVo
45189
Is this a residential or commercial protect? ❑ Residential 1216immercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage ��
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office C�TOfnce ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes ❑ No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work _I
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: list the company name or Gty of Collins license #
Electrician Plumber MP610 Mechanical Roofer Other
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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 budding construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: Z_2-7 /
Print Name: Daniel Ormesher Signature Date
Revised 11232016