HomeMy WebLinkAbout2960 W Stuart St - Applications/Water Heater - 10/03/2018City of Planning, Development, & 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 ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation �J' Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer. V
Complete all applicable information on the application. Incomplete applications wil not be accepted.
Application #�
Forolirce use only
Date 10 3
Job Site Addres (required) Value of Construction (labor, materials, profit)
on ItaAzoz� 0 52(0
Property Owner Name Address City/State Zip Phone
(106vi Co &526 9-7 0232
A licant Name Address City/State Zip Phone
lU o Ow On ?OZ29 .3 - 6s
Contractor Address City/State Zip Phone
b'ir'l Co 2 302067
Contractor City of Ft. Collins ales Tax'4J Are you paying taxes here or by report? ere ❑ Report
Sales tax number is required 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: 9,,Single Family Detach ❑ 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 Ifyes, you may need to cont3ctHistoric Pfeservadon
If this is for a demolition permit, what year was the building constructed?
Description of work
Qgio 3c r co v r
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L/st the company name or Gty 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: Buno
6��_Date
Print Name: Signature A.
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Revision date 2IM017