HomeMy WebLinkAbout338 E Pitkin St - Applications/Water Heater - 02/26/2018Fit of
Planning, Developmei
Community Develop
281 North College Avenue
Fort Collins, CO 80524
t, & Transportation Services
Lent & Neighborhood Services
Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER, PERMITS ONLY
This application is to be used to apply for the following perm
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet St
manufacturer).
Complete all applicable
'information on the application. Incoi
Application # 1 5 1 S O 11
For office use only
s only (check all that apply). ❑ Air Conditioning
ervice change) ❑ Gas Lighter ❑ Gas Log
❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
ie (must be EPA certified, provide make, model and
applications will not be accepted.
2 Z(k- J
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State
Po S-" Zk l ZL 6z A Cfj
Zip Phone
Fr" Co SOSZS 61,10 Z. 5' 3 sb
Applicant Namle�- Address City/State
Zip Phone
1Contractor II Address City/State
VAII � F6mLim rruvl
Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying
Sales tax number is required by all contractors. Are you paying
taxes here or by report? ❑ Here ❑ Report
with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Residential ❑ 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 ❑O
Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ YesXNo If yes, youlmayneed
to contact Historic Preservation
If this is for a demolition permit, what year was the building constrlucted?
Description of work
4
*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
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: Lt 1ndA pof'(Y Io AA
j 2"�O'
Print Name: Signature ��—
Date
I
Revision date 2/6/2017