HomeMy WebLinkAbout2754 Pampas Dr - Applications/Water Heater - 12/12/2017i
Uty of Planning, Dev opment, & Transportation Services
,,,Fort Collins , Community Development & Neighborhood Services
281 North Colle a Avenue
Fort Collins, C 80524 in 970 416 2740 Fax 970 224 6134
OVER -THE -CO NTER ERMITS ONLY
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 ❑iWater Line ❑ W
manufacturer) I
Complete all applica(bllee information on the applii
Application #
For office use only
iermit only (check all that apply). ❑ Air Conditioning
(not service change) ❑ Gas Lighter ❑ Gas Log
rent MRoofing ❑ Sewer Lme ❑ Photo -voltaic
A Stove (must be EPA certified, provide make, model and
applications will not be accepted.
I-;?I)-2-I1-►
Job Site Address (required)
e(j
Value
of Construction (labor, materials, profit)
1J cc
Property Owner ame Address
a 25��f
G
/State- Zip Phone
A plicant Nae Address :
Contractor C Address
G
4 Ci
/State Zip Phone
/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying
taxes here or by report? ere ❑ Report
Sales tax numbers required by aff contractors
Are you paying
with your trust account? 11 Yes ❑ No
Is this a residential or commercial project? Residential
If residential, is it ingle Family D ch d ❑ C
Multifamily I (apartment) ❑ G
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ H
❑ Restaurant, ❑ Other (explain
❑ Com
do/townho
rage
el/Motel ❑
ercial
a (single family attached) ❑ Duplex
Medical office ❑ Office ❑ Retail
If yes, you
Is this building 50 years of age or more? O Yes ❑ No
77ay need to contact Historic Preservation
If this is for a demolition permit, what year was the b
ilding constru
cted?
Description of work
L
("; ,
�r
i
*If lawn sprinkler/backflow preventer, must list licensed plu
ber. If first-time
A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Golly
s license #
Electrician Plumber Mechanical
Roofer Other
I hereby acknowledge that I have read this application and
comply with all requirements contained herein and city ordir
tate that the
ances and sta
above information is complete and correct I agree to
a laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name �� I Signatur
i
Date I Z i Z j
Re"wan daft 216/2017
if