HomeMy WebLinkAbout6102 Claire Ct - Applications/Water Heater - 11/12/2017Cityaf
Fort Collins Planning, Development, & Transportation Services
Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main_ 970.4162740 Fax 970224.6134
OVER-THE-COUNTER PERMITS ONLY
This appPrcation is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non-structural) El Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating link ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove er). (must be EPA wed, provide make, model and
manufacturer).
Complete all applicable information
/on the application. Incomplete applications will not be accepted.
Application # ` �Vr,� �� Date%2/� 6r7
For office use only
Job Site Address (requued)
(�fC2 CQk,." Gvr.& f�.
Property Owner Name Address
I�P.� ew, GIB
Appli�nt Name Address
Value of Cogsb uetion (labor, materials, profit)
City/State
City/Stage
City/State
zip Phone
Zip SOS; 7 Phone 97 U
-,,./ 65to
ZlPfC6j7 PhoneQ-70
for City of FL Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Mmbw is requaed by a# cvnbactors
Are You Paying with your trust account? ❑Yes ❑ No
Is this a residential or uncialro Pt? Residential ❑Commercial
If residential, Is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Nultifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ gar ❑ Church ❑ HoWMotel ❑ Medkal office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No rfyes, ytw may need to conlactHkWoric plena Vm
N this is for a demolition per., what year was the building Constructed?
Description of work
*If lawn Wrhtkler/backftow preventer, must list licensed plumber. Ii first-time A /Cr must Est licensed electrician.
Subcontractors [ rsY the oamparryrrrame or �yTy pfgCol/ins Ikvsrse
eectricnar Plumber Mechancal Roofer.
Other
I hereby acknowledge that I have read this application and state that the above informations 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 Isaii .
Applicant:
Print Nam
RSAUOn dato uarmi?
Signature
Date
Z'd trL0861,90L6 do l'ZO 91• SO Uer