HomeMy WebLinkAbout1909 Churchill Ct - Applications/Water Heater - 09/16/2019Planning, Development & Transportation
CCity of 281 N. College Ave P.O. Box 580
_P 6rt Collins Fort Collins, CO 80524
'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). ❑ 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 O Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable
�information on the application
U�'"I Application # I Uq �`�
For office use only
Incomplete applications will not be accepted.
Date 9/13/2019
Job Site Address (required)
Value of Construction (labor, materials, profit)
1909 CHURCHILL CT
$1,425.00
Property Owner Name
Address City/State Zip
Phone
WILLIAM COLEMAN
1900 LAKESIDE DR, MCCALLA AL 35111
Applicant Name
Address City/State Zip
Phone
DRAKE MANOR MGT
2821 REMINGTON ST #100, FTC CO 80525
970-493-4052
Contractor
Address City/state Zip
Phone
NORTHERN COLORADO AIR INC.
812 STOCKTON AVE, FT COLLINS CO 80524
970-223-8873
Contractor City of Ft. Collins Sales Tax
# Are you paying taxes here or by report?
El Here ❑ Report
sales tax number is required by all contractors.
Are you paying with your trust account?
DE Yes ❑ No
26862
Is this a residential or commercial project? El Residential ❑ Commercial
If residential, is it: O 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 0 No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work REPLACE WH
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license 9
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: KARENA
Print Name: KARENA HUNTWORK Signature HUNTWORK _°"� GG MFRMM°'°s pate 9/13/2019
mi.: 201901 M 19 ma14TW