HomeMy WebLinkAbout2319 Berkshire Dr - Applications/Water Heater - 10/09/2018CI*L11 c*� Planning, Development, &r 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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit P Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacture .
Complete all applicable information on the application.
Application # 6JEpa3
For office use only
Incomplete applications willl of be accepted.
Date L�/�% r
Job Site Address) (required) �? Value of Construction (labor, materials, profit)
Property Owner NanU Address . City/State Zip Phone
ApplicAnt Name Address (1 City/State Zip Phone
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Contractor Address City/State Zip Phone
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Contractor City of Ft Collins Sales # Are you paying taxes here or by report? ere ❑ Report
sales tax numberisrequiredbyall contactors. Are you paying with your trust account? Ves ❑ No
Is this a residential or,�corpmercial project? Residential ❑ Commercial
If residential, is it: I,d jingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
fj� 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 Ifyes, you may need to contact HistoricPreservatron
If this is for a demolition permit, what year was the building constructed?
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#
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: IN*
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Print Name: I / N Signature Date —t ll y
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Revision date 2/62017
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