HomeMy WebLinkAbout1900 Pawnee Dr - Applications/Water Heater - 08/16/2018 (2)Cltyof 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) .0 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit .❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line 17 Photo -voltaic
❑ Ventilation ® Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable rmation on the application.
Application #
For Aire use only
Incomplete applications will be accepted.
io
Date a — `u
Sob Site Address (requned) Value o Construetlon (labor, materials, profit)
0 r $7
Property Owner Name Address City/State Zip Phone $-9
1
- l
Applicant Name Address CityState Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fart Collins, CO 80524 970.484.4552
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ■ Report
Wes bwnLftwIsrequimdbyar7crrtraabm Are you paying with your trust account? 0 Yes ❑ No
Is this a residential or commercial project? ■ Residential ❑ Commercial
If residential, is it: ■ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
13 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 13 Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact H/storic Pre."wdon
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/bacldkaw preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or 01 y offt Colons Acense .E
Bectidan Plumber. Mechanical H1309 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 contortion. I know that a
permit is not valid until it has been paid and Issued.
Applicant:
Print Name: Signature SdLl1,-t_(� Date
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