HomeMy WebLinkAbout537 Strachan St - Applications/Water Heater - 01/26/2018Planning, 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 # 6 0 0 0011bot Date
For office use only
]ob Site Address (fwulred) Value of Construction (labor, materials, profit)
53 rat, Lit- ig t5 r
Property Owner Name Address City/State Zip Bos- Phone
K fo ,4 e- S, 7 5-f10- D � yyl4Os1
Applic nt Name Address City/State Zip Phone
3e lm WalkalaSs Wa $oSaS 7a-J -
Contractor Address City/State Zip Phone
Geoa Go Zi Parfie Se V,<4EJ 170_ 1?-8 B
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here C9 Report
sales tax number Isrequmedbyallcontradws Are you paying with your trust account? Yes ❑ No
Is this a residential or commercial project? <1nesidential ❑ Commercial
If residential, Is it: ❑ Single Family Detached J15<6ndo/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? ❑ Ye�No if yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Re Dluc-e, exi y�inA w«4if- ke4el- will oo, P.lecAri C
sa g aIIon Wa}6- k eat el
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or Qty 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.
Prriint Name. DaMp, La I
Signature Date i'26
Reneon date MOW