HomeMy WebLinkAbout1078 Tierra Ln - Applications/Water Heater - 11/13/2018Nov 13 2018 08:44AM Swan 9706130826 page 1
City 0" Planning, Development, & Transportation Services
,Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Coffins, CO 8=4 Main: 970.416.2740 Fax: 970.224.8134
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
X Heating. Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voltak:
❑ Ventilation 0 Water Heater ❑ Water Line ❑ Wood/Pallet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all apMMM
n n h0 lie "on. Incomplete applications will not be accepted.
Application # Date --�_itil3llg
For arse use only
Sob Site Address (nrqulred) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
nn
FOR Labd& MR I&PO
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of .Collins Sales Tax # Are you paying taxes here or by report? XHere ❑ Report
-Wag raxnwnbarurequrredbyall roncrcm►x Are you paying with your trust account? % es ❑ No
Is this a residential 0 mmerdal project? �Reskientlal ❑ Commercial
If Is it:
residential, ❑
WSIngle Family Detach COndo/townhome (single fam❑ ily attached) Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar Cl Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (ex In}
Is this building 50 years of age or morel ❑ Y No If yes, you may need to coniactHLKoricPreservatlon
If this is for a demolition permit, what year was 11buildlng constructed?
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber I rst-time A/C, must list licensed electrician.
Suboontraetorn: List the company name or [Sly OR ColhIns lrcense #
Electrician Plumber Mechaniml 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 brow that a
permit is not valid until It has been paid and Issued.
Applicant:
Print Name: g
signatu �teAll