HomeMy WebLinkAbout6120 Claire Ct - Applications/Water Heater - 01/11/2018Jan 11 2018 05:56PM HP Fax 9706130826 page 1
C_City of Planing, Development, & Transportation Services
�7M `� Runs Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970A16.2740 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 (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
manufactur111
er).
Complete all applicable Information eaapplication.
Appiicatlon # 06 N
For ofte use only
Incomplete applications will not be accepted.
Date UL11 I I &
Job Site Address (mw1red) Value of Construction (labor, materials, profit)
a159V0
Property Owner Name Address City/State Zip Phone
-aau-1as3
Applicant Name Address city/State Zip Phone
Contractor Address City/State Zip Phone
V 5
Contractor City of Ft. iEoilins Sales Tax # Are you paying taxes here or by report? VHere ❑ Report
-%'W fax nambar,Erre4~dyall Are you paying with your trust account? ?(Yes ❑ No
Is this a residential or commercial project? VResldential ❑ 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 (ex lain)
Is this building 50 years of age or more? ❑ Yes ( No If yes, yew may need m contactHistoric: preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/q must list licensed electrician.
Subconbaetors: L& the company name or Oty of Ft Collins ff6ense #
Bectridan Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this applkation 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
Print Name: Slgnatu Date I I 1
Rwiaon d96 smnan