HomeMy WebLinkAbout6570 Rookery Rd - Applications/Water Heater - 02/26/2019 (2)City of Planning, Developments & Transportation Services
Fort Wlins Community Development & Neighborhood Services
�- 281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 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) ❑ FJectical 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 # 1410 / I 7 (� Date February 26, 2019
For offm tar a*
lob Site Address (mqu/nadJ Value of Construction (labor, materials, profit)
6570 Rookery Road, Fort Collins, CO 80528 $1882.75
Property Owner Name Address 6ty/State Zip Phone
Jayson Penn 6570 Rookery Road Ft Collins, CO 80528 970-397-6692
Applicant Name Address City/State Zip Phone
Chs''ibit a1FVa4U 101 S UvikLan& Ftco; CO 80524 494-7632
Contractor Address Qty/Stabe ZiPP Phone
AllevvServCCe 101 S Ur&h LaNre Ftco; CO 805Z4 484-4841
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑� ere ❑ Report
�estar muiber®t&W byaitmn6atwm Are you paying with your trust accourV'TX0ees ❑ No
10010
Is this a residential orgrimercial project? .Residential ❑ Commercial
If residential, is it: '$Single Family Detached ❑ Condo/trnmhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: Q Bank ❑ Bar ❑ Church ❑ Hotel/Mote! ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Yyes, yvu mayrwed to mntrctfksturicPresewiihn
If this is for a demnlftion permit, what year was the building constructed?
Description of work Remove existing w/h and replace with like new w/h 2 of 2
*If lawn sprinkrer/bacidtow preventsr, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: List compmyname or offt Ca fhs/kww #
@ecwdm Plurber Medhankal Roaf r Other
I hereby admowledge 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 consbudion. I know that a
permit is not valid urdil it has been paid and issued. �n fl `/ 7 j
Pont Name: C�1a ibiWlu��VGiM� Signature �/' h' L19lX t+t t/ JCilttI pate ��` f