HomeMy WebLinkAbout1427 Curtiss Ct - Applications/Water Heater - 02/15/2018City 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
manufacture
Complete all applicable information on the application. Incomplete applications will not be accepted
Application # 0 V ! ql
For otf1ce use only
Date Z"--/ 6 �-/
Job Site Address (required) Value of Construction (r, materials, profit)
l 7 Cvn- i s S .�?L, 1,3,50
4110
Property Owner Name Address City/State Zip Phone
T06 k 5 t F-C 60 52,8
Applicant Name Address City/State Zip Phone
GhU(.k /(Q,/ rvl�S
Contractor Address City/State Zip Phone
7 r>'�00 t�%bL►S6o1%t G�< zz5-u 8Z -
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax nul
Per srrtoredbyallcontractors Are you paying with your trust account? 9'Yes ❑ No
Is this a residential or c mercial project? esidential ❑ Commercial
If residential, is it: Single Family Detac ed ❑ 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 Ifyes, you mayneed to contact HistoncPreservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*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.
Applicant: /� 11 • ,.,�
Print Name. L n "��tt� Signature Date L V 5
Reviwn date 2/6/2017