HomeMy WebLinkAbout2721 Killdeer Dr - Applications/Water Heater - 12/07/2018CltYor' 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 El 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 # I '\ v 1 0�0 � y
For ogre use only
Date December 7, 2018
Job Site Address (required) Value of Construction (labor, materials, profit)
2721 Kraldeer'DrEve, >=ortcoNi4As; co 80526 $1901.00
Property Owner Name Address City/State Zip Phone
LL4n Wat,3, 2721 Xa&eerDrwe, FortCoW:4v,CO 80526 970.226.1265
Applicant Name Address City/State Zip Phone
Chv(.bti ut.FvaN14 101 S LGytk.Lavw� /=tCo-, CO 80524 494-7632
Contractor Address City/State Zipp Phone
AUe+i1Se, vtce 101 S LLytk�La.ne ;FtCo; CO 80524 484-4841
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑yere ❑ Report
Sales tax numberisrequirLdbyallcontractors. Are you paying with your trust account?'VYes ❑ No
10010
Is this a residential or cQmmercial project? WResidential ❑ Commercial
If residential, is it: V Single Family Detached ❑ 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 If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Re+vwve-ex. VvnW+v/iva+ut,replace,IvUfvrwAv likeJw7_V
*If lawn sprinklerlbackflow preventer, must list licensed plumber. if first-time A/C, must list licensed electrician.
Subcontractors: List Uie companyname 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, 1 ` Applicant: CYLi'VWo 'v �VG{ t t� �yr il� ['� h 1,1 A/l l +l l �� 3'
Print Name: Signature h,i Date
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