HomeMy WebLinkAbout2300 Cotswold Ct - Applications/Water Heater - 02/09/2018City of Planning, Development, & Transportation Services
Fort Collins 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 (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)
Complete all applicable information on the application Incomplete applications will not be accepted
Application #e)\6p69Ty Date a ref e.
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
9300 C�-S%Vdlj C+ � �Gv
Property Owner Name Address City/State Zip Phone
o a 0-^ z% 6 w NAMe (Itn3 ea5j 3513-92
Name Address City/State Zip Phone
m r
Contractor Address City/State Zip Phone
6(i v1VAL 5>0( an F}-C,II F Ce(lin 0-S07-
Contractor City of Ft. Collins Sales Tax # Are y u paying taxes here or by report? Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it. ,Wsingle 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 contactHlstonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work a c.
r
*If lawn sprinkler/backHow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Colons 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.
Applicant: /' n
Print Name 1 O 1� C` f l f Signatu Date
RevMon date 2/6/2017
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