HomeMy WebLinkAbout3106 Cumberland Ct - Applications/Water Heater - 12/27/2018Planning, Development, & Transportation Services
,FOI-t 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 Water 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 # M U DO H Date 12 2�1 is
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
quo- 223• Z1"1
Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
es 8052y L4&4 ROB
Contractor City of Ft. Co ins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax number is required by all contradom Are you paying with your trust account? XYes ❑ No
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Is this a residential or c mmerciai project? Residential ❑ Commercial
If residential, is it; Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church 0 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No If yes, you may need to contact HistoricPreservation
If this is for a demolition permit, what year was the building constructed?
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*If lawn sprinkler/backflow preventer, must list licensed.plumber. If first-time A/C, must list licensed electrician.
Subcontractors:List the company name orCity ofFtCollins 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:
Print Name: At G Signature Date
Revision date 782017