HomeMy WebLinkAbout712 Tyler St - Applications/Water Heater - 12/27/2017City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
/��h 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 -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 to .—If.
Application # �11t>0936 Date M-7- 710
Fnr nffi'rP use Only
NJobe Address (required) Value of Constrruction (labor, materi , profity Own r Name Address City/State Zip jPhone
Q.
Applicant 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 "eport
sales tax number Is required by allcontractols Are you paying with your trust account? ❑ Yes P40
45189
Is this a residential or commercial project? esidential ❑ Commercial
If residential, is it: ingle Family Detached ❑ Condo/townhome (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 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 e
*If lawn spnnkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or City of Ft Collins license #
Electrician Plumber MP610 Mechanical Roofer Other
Feby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
ply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
mit is not valid until it has been paid and issued.
Applicant: 2 17
Print Name: Daniel Ormacher Signature Date Z v
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