HomeMy WebLinkAbout7020 Barbuda Dr - Applications/Water Heater - 10/16/2018�i° Planning, Development, & Transportation Services
�F6k 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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Um ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilations Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacture
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #
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For office use only
Date V I Jj
Job Site Address (required) Value of Construction (labor, materials, profit)
Boa �� 1 � F7 - CG
Poperty Owner Name Address City/State Zip Phone
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licant Name _ Address City/State Zip Phone
Z: G'(/� 7�j 0 �J� 1�-�'Z " � �;�,>?,1. 2 il0
Contractor Address City/State Zip Phone
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Contractor City of Ft. C ins Sales T # Are you paying taxes here or by report? Here ❑Report
sales tax number is mquired by all contractors Are you paying with your trust account? Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: Single Family Deta ed ❑ 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? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work iri V
L'
*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 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: / i
Print Name: (1 t') ( Signature I Date
Revision dalc 2/6/2017 `-��