HomeMy WebLinkAbout3749 Kentford Rd - Applications/Water Heater - 10/11/2018Ave
(� City of Planning, Development & Transportation
281 N. CoF6rt Collins Fort Co I nls, CO 80524 P.O. Box 580
Phone 970-416-2740 Fax 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 -voltaic
❑ Ventilation XWater 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 # Gil COUq 0 2-3 Date
For office use only
Job Site Address (required),
Value of Construction (labor, materials, profit)
S 1 DD
Property Owner Name
Address
City/State Zip
Phone
Oa6os
11 OS
Applicant Name
Address
City/State Zip
Phone
e 305 -
-
Contractor
Address
City/State Zip
Phone
-
q
Contractor City of Ft. C ins Sal Tax #
Are you paying taxes here or by report? ❑ Here
;KReport
Sates tax number isrequir by allmntracrors.
Are you paying with your trust account? JZ(Yes
❑ No
Is this a residential or commercial project? XResidential ❑ Commercial
If residential, is it: XSingle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ 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?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*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 A
Electrician Plumber—M—P 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:
Print Name: 4 or-1 CLn Signature
Date