HomeMy WebLinkAbout2824 W Stuart St - Applications/Water Heater - 09/20/2019Firs ���on� Planning, Development, & Transportation Services
�w Community Development & Neighborhood Services
`�— 281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 Fax 970.224.6134
OVER -THE -COULTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
D Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Hone 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 injfformation on the application. incomplete applications will not be accepted.
Application # �in
' ` q) 1 1 `� � Date September 20, 2019
For aMb--tgeof*
lob Site Address (requhe7 Value of Construction (labor, materials, profit)
2824 W Stuart St, Fort Collins, Colorado 80526 $6285.00
Property Owner Name Address Gty/State ZIP Phone
Garrett Mumma 2824 W Stuart St Ft Collins,CO 80526 970-692-3508
Applicant Name Address city/State Z�'1pp Phone
Christina Evans 1015 Link Lane Ft Co, CO 80524 494-7632
Contractor Address City/Stage Zip Phone
Allen Service 1015 Link Lane Ft Co, CO 80524 484-4841
Contractor City of FL Collins Sales Tax # Are you paying taxes here or by neport7 ❑Mere ❑ Report
Sees tax [smwjedbya9 Are you paying with your bust amount? Yh?s ❑ No
10010
Is this a residential or 9mmercial project? Residential 0 Commercial
If residential, is it V Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: Cl Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Jfyw you mayrreed to crntactKcstark Piesrervm on
If this is for a dermorition permit, what year was the building constructed?
DeSCription Of work `� w c °ds "' wM aW rcpf with. � twMk= wit+
*If Yawn sprinkler/bacdiow prevernter, must list licensed plumber. If firs -time A/C, must list licensed electrician.
Subcontractors W Me cvwpwWnww ar Otyaffr CaMis himme 9
Embidan Plumber Medhanlml Roarer 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 build'mg construction. I know that a
permit is not valid until it has been paid and issued. Pa CrituuvFvacos
Print Name: Signature(Wnsxrn fn �. q IZ0jt
hts�ame��ao