HomeMy WebLinkAbout4751 Pleasant Oak Pl - Applications/Water Heater - 02/12/2018Feb 12 2018 07:19PM HP Fax 9706130826
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,For;; �; of Planning, Development,
rt Cothns Community Developme
281 North College Avenue
Fort Collins, CO 80524 b
OVER-THE-COUNTER P
This application is to be used to apply for the following permits
❑ Demolition (Interior non-structural) ❑ Electrical Alteration (not ser
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Horne replacement ❑
❑ Ventilation XWater Heater ❑ Water Line ❑ Wood/Pellet Stove
manufacturer).
Complete all applicable Information on the application. Incompi
Application #- 1 D I b
For office use only
Transportation Services
& Neighborhood Services
970.416.2740 Fax: 970.224.6134
ITS ONLY
(check all that apply). ❑ Air Conditioning
change) ❑ Gas Lighter ❑ Gas Log
Ming ❑ Sewer Line ❑ Photo -voltaic
at be EPA certified, provide make, model and
applications will not be accepted.
Job Site Address (required) Value of Construction (labor, materials, profit)
§k
Property Owner Name Address City%State Zip Phone
Applicant Name Address City/State Zip Phone
Contractor Address City/ State Zip Phone
a
Contrador City of R.16ollins Sales Tax # Are you paying taxes here or by report? 14 Here ❑ Report
Sales raxrxrmberisroodredbyall amnaMs. Are you paying with your trust account?` Yes ❑ No
Is this a residential or commercal project? X Residential ❑ Commercial
If residential, Is It ❑ 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)
Is this building 50 years of age or more? ❑ Yew No If yes, you may need to contact H5WnC Pre5ervddon
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 firsttitime
A/C, must list licensed electrician.
Subeo ors: List the company name or dly of R Co!/kris dct^ns-10
Decbician Plumber Mechanical
I
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 brow that a
permit is not valid until it bes been paid and issued.
Print
tName: we re."ifi
Date
I
v �
Rr Mw date 2JO12017
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