HomeMy WebLinkAbout1602 Northbrook Ct - Applications/Water Heater - 09/25/2018City. Planning, Development, & Transportation Services
t.Vlllns Community Development & Neighborhood Services
MI North College Avenue
Fort Collins, CO 80524 Main: 970AI6.2740 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-volhaic
❑ Ventilation % Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)_
Complete all applicable information on the application.
Application # U,1b `y�i l I L4
Forolfre tae on/y
Incomplete applicationsT11cff ill not be accepted.
Date � ,-
lob Site dress ( / Value of Construction (labor, materials, profit)
l �n
II T 001 i, / 15 l ;
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Property Owner Name Address City/State Zip Phone
I
Applicant Name Address City/State Zip Phone
01'I'mc,n 1Q,
aI `2t m ,
�(; 303-W-5765
Contractor Address ty/State Tip Phone
� Q-t &)aQq 303-M-5-705
Contractor City of Ft Codlibs Sales -r=W # Are you paying taxes here or by report? Here ❑ Report
sales taxnumder f;m edbyamWmdas. Are you paying with your trust accountes ❑ No
Is this a residential or commercial project? 7Residential ❑ Commercial
If residential, is it: ❑ Single Family Detach ❑ Condo/hownhome (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? ❑ Yes O No If yes, you Mayneed to mnlact HisMijC praese 017
If this is for a demolition permit, what year was the building oonstructed?
Description of work
i12 +' r
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/Cr must list licensed electrician,
Subcontractors: List the company name or City of Ft Coffins ffcerrse #
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 isued
Applicant C�/N60
` 1� yil ls(Print Name• ignatame Date
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