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HomeMy WebLinkAbout2900 Skimmerhorn St - Applications/Water Heater - 11/28/2018city/ of Planning, Drelapment.61Trangportation 281 N. College Ave P.O. Box 580 Fort Collins, Co 80524 Phone 970-416-2740 Fax 224-6134 O'' ER-TRIE-COU lTER PERMITS ONLY This application is to be used to ap101y for the following permits only (check all that apply). ® Air Conditioning 0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) D Gas Lighter ® Gas Log I] Heating Unit ❑ Lawn Sprinkler I1 Mobile Home replacement ❑ Roofing ❑ Sewer line ❑ Photo -voltaic El Ventilation XWater Heater ® Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application #., ZLPS�' For offite use only job Site o- m Address Address City of Ft?Collins Sales -lax # SallbxnvwtsrEFrequkadbya#Cvf' aCt Date Value of Construction (labor, materials, profit) Zip Phone Zip ,, Phone Zip Phone Are you paying taxes here or by report? EI Here zpepojrt Are you paying wt`+h your trust account?,X Yes El No Is this a residential or m mercfal project? gRestdential ❑ Commercial if residential, is it: SiSingle Family Detached ® Candoltownhome (single family attached} ®Duplex Multifamily (apartment) is Garage if commercial, is it: ® Bank ❑ Bar ❑ Church ❑ Hotel/Mote l Medical office ❑Office ©Retail ® Restaurant ® other (expla n) Is this building so years of age or more? ❑ Yes No If YDU may need to cantaetElsa©rfcPri~seNatlon If this is for a demolition permit, what year was the building constructed? if prior to 1975, you w111 need an asbestos assessment to submit wig, this appllcatlan. Description of work *If lawn sprinklerlbaddtow preventer, must list licensed plumber. If first-time A1C, must list licensed electrician. subcontractors: List the company name ar City of Ft CV"..Fns license Eledtrtcian Plumber Mechanical,R13Dfer 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 hereln and city ordinances and state laws regulating building constructlon. i know that a permit is not valid until it has been paid and issued. Applicant: Hate L prirrt Name: r i Signature 9