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HomeMy WebLinkAbout1613 Sagewood Dr - Applications/Water Heater - 01/03/20192YS7 ( City of Planning, Development, & Transportation Services Flirt Collins Community Development & Neighborhood Services 281 North College Avenue Fort Collins, CO 80524 Main: 970A162740 Fa)c 970224.6134 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 # '?)\�7(-.61A S Date For office use only Job Site Address (required) Value of Construction (labor, materials, profit) lie 11 1,6 -oo Property Owner Name Address City/State Zip Phone V" l(Q fir. ` orA 0ib o a� Applicant Name Address City/State Zip Phone Contractor Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report sales tax number isrequired 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: ® 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 workMwt&AL Zn zits laakLems k-j2k9f k4lkiPC *If lawn sprinkler/backilow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or Gty of Ft Collins license # ElecbidaJa4&QS6e 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: kc� PrintName:Qn - tCwtcm Signaturel��u"'� Date 1 3�CP Revision date 2/62017 i 't. .. ... Ji Vr"