HomeMy WebLinkAbout324 Vivian St - Applications/Water Heater - 09/25/2019of Planning, Development & Transportation
City
F — __1 Collinsor N. College Ave P.O. Box 580
r�[_`'("i ` 1 1.7 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. Incomplete applications will not be accepted.
Application # F 19 � )0 Date
For office use only
9/24/2019
Job Site Address (required)
Value of Construction (labor, materials, profit)
324 VIVIAN ST
$3,280.00
Property Owner Name
Address City/State Zip
Phone
TIM TICE
324 VIVIAN ST, FTC CO 80525
480-694-2916
Applicant Name
Address City/State Zip
Phone
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?
❑ Yes ❑ No
26862
Is this a residential or commercial project? El Residential ❑ Commercial
If residential, is it: El 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 N 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 WATER HEATER
*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 #
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 pate 9/24/2019
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