HomeMy WebLinkAbout614 Alpert Ct - Applications/Water Heater - 09/30/2019City of Planning, Development & Transportation
FOr-t Col
�I�� 281 N. College Ave P.O. Box 580
v 1 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 ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ 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 # 0 1 RgoI Date
For office use only
Job Site Address (required)
Property Owner Name Address
k L .� I ..
scant
Contractor City of Ft. Collins Sal' al Tax #
Sales tax number is requ/red by all contractors. 2Q I D
Value of Construction (labor, materials, profit)
b I .,am
to Zip _ Phone
Phone
Phone
Are you paying taxes here or by report? Ces
ere ❑ Report
Are you paying with your trust account? ❑ No
Is this a residential or commercial project? b� Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
1 k 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 ❑ No If yes, you may need to contact HistoricPreseruation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ustthe companyname orCity ofFtCollins license ,
Electrician Plumber !20'
---_ Mechanical Roofer
—__ Other _
I hereby acknowledge that I have read this application and state that the above Information is complete and correct, I, I agree
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.
PrintApplicant: � _LM"- 4gnature
Print Name: ,C `' I 111 �Zn� Date r LJV