HomeMy WebLinkAbout531 Flagler Rd - Applications/Water Heater - 12/29/2017Dec 29 2017 05:34PM HP Fax 9706130826
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City of Planning, Development, & Transportation Services
I'�i1S Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax 970.224.6134
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 (mtenor non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 9 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
Application #
faro -Ake use only
Date�-
Sob site Address (nequJieO Value of Construction (labor, matenals, profit)
ci3i naaa Rd C51go 00
Property Owri6r Name Address City/State Zip Phone
Applicant Name ddress City/State Zip Phone
Contractor Address City/State Zip Phone
+h 80538 S
Contractor City of Collins Sales Tax # Are you paying taxes here or by report? Jq Here ❑ Report
SA/estarrnunberkregdredbya#con"ctws. Are you paying with your trust account? XYes ❑No
Is this a residentlal or mmercial project? Residential ❑ Commercial
If residential, is d: Single Family Detached ❑ Condo/townhome (single family attached) ❑Duplex
❑ Multifamily (apartment) ❑ Garage
If commerdal, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building so years of age or more? ❑ Yes-V No If yes, you may need m contact Historic PrEsevvahon
the building constructed?
If this is for a demolition permit, what year was
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: W the company name or Cty of Ft Collins license #
Electroan Plumber Mechankal 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 R has been paid and issued.
Applicant:
�a) �-
Printr!y,� Date
Rmsion dM 2&Ml?