HomeMy WebLinkAbout637 Bear Creek Dr - Applications/Water Heater - 12/21/2017Q��
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 O 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 # 1021 :1 l I Date 12/21/2017
For o>i,ce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
637 BEAR CREEK DR
� $1,395.00
Property Owner Name
Address City/State Zip
Phone
KENT RICHARD
5456 TILLER CT FORT COLLINS CO 80528
970-231-0645
Applicant Name
Address City/State Zip
Phone
Contractor
Address City/State Zip
Phone
NORTHERN COLORADO AIR INC
812 STOCKTON AVE, FT COLLINS CO 80524
970-223-8873
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
9 Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
❑O Yes ❑ No
26862
Is this a residential or commercial project? E Residential ❑ Commercial
If residential, is it: ID 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) L
Is this building 50 years of age or more? ❑ Yes ®No Ifyes, you mayneed toi contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work REPLACE WATER HEATER
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber 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. i
I
Applicant: KARENA
Print Name. KARENA HUNTWORK Signature HUNTWORK E"""®"`AGAIW " VS pate 12/21/2017
om �memm,amu mm