HomeMy WebLinkAbout739 Stonington St - Applications/Water Heater - 12/27/2018Planning, Development & Transportation
city of 281 N. College Ave P.O. Box 580
F6r} Collin Fort Collins, CO 80524
{, .7 Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 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
Stove (must be EPA certified, provide make, model and
❑ Ventilation ater Heater ❑ Water Line ❑ Wood/Pellet
manufacturer
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #
13��1
�6G� Date
For office use only
Value of Construction (labor, matengis�pro����
job site Address (required) o
C Phone
Address City/State Zip
Property Owner Name r G \ �[
Way �� tLX
Applicant Name
Address L city/State Zip
Phone
Address City/State Zip Phone
Contractor
t
Contractor City of Ft. Collins les Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Are you paying with your trust account? ❑Yes ❑ No
Sales tax number Is required by allmnbactors
Is this a residential or co mercial project? Residential ❑ Commercial
If residential, is it: �S 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 Wo If yesj you may need to contact Historic Prawrvation
If thls Is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins //tense #
Electrician Plumber f �Z2 0 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 Nam
Date /P - 7/�