HomeMy WebLinkAbout1900 Larkspur Dr - Applications/Water Heater - 09/10/2018FCttyof Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Services
�v 281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.274D 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 P Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation Iff 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 # Mcb c)195 0 Date September 10, 2018
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
1900 Larkspur Drive, Fort Collins, CO 80521 $1921.00
Property Owner Name Address City/State ZIP Phone
Terrance Russell 1900 Larkspur Drive Fort Collins, CO 80521 970-419-8617
Applicant Name Address Clty/State ZIP Phone
Christina Evans 101 S Link Lane Ft Co, CO 80524 494-7632
Contractor Address City/State Zip Phone
Allen Service 101 S Link Lane Ft Co, CO 80524 484-4841
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑Mere ❑ Report
Sales iaxnumber isrequired by all contractor. Are you paying with your trust account? ' Yes ❑ No
10010
Is this a residential or cynmercial project? Tpesidential ❑ Commercial
If residential, is it; V Single Family Detached ❑ Condo/townhome (single famiy attached) Q Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: El Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Yyes, you may need to contact Historic Pfeservation
If this is for a demolition permit, what year was the building constructed?
Description of work Remove existing WH and replace new similar WH.
*If lawn sprinlder/backilow 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
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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:
Print Name: Christina Evans Signature hmffa Date D
Ramer dole 12Sr417