HomeMy WebLinkAbout1131 Muirfield Way - 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 -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make,, model and
manufacturer) �7
application. Incomplete applications will not be accepted �J �- +?J
Complete all applicable information on the
Application # E bMze Date
jr,, .Mo neP nn/v
Job Site Address Zi
d)Value of Construction (labor, materials, profit)
W2
Property Owner Name
dress City/State Zip Phone
Applicant Name
Address City/State Zip Phone
Daniel Ormesher
Con=endent
Address City/State Zip Phone
IndPlumbingSolutions, 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 Re ort
Sales tax number is required byall contractors Are you paying with your trust account? ❑ Yes !9'N0
45189 -
Is this a residential or co mercial project? Residential ❑ Commercial
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 ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact H/stonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn spnnkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Lest the company name or City of Ft Collins license #
Electrician Plumber M2610 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: Date
Print Name: Daniel Cirmacher Signature
Revised 11/232016