HomeMy WebLinkAbout1766 Deweese St - Applications/Water Heater - 09/27/2019Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins,
CO 80524
Phone 970-41616-27402740 Fax 224-6134
OVER-THE-COUNTER PERM11M ONLY
This application is to be used to apply for the following permits only (check all that apply).
IXAir Conditioning ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ($"Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ Ventilation IX 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 # Q 19 � � q, -- 619 I C12C14 Date q6iqla
For office use only I q I •�).Q Q -�
Job Site Address (required)
Value of Construction (labor, materials, profit)
s
U0i9 LLD
Property Owner Name Address
City/State Zip
Phone
Maw oun
nsau
a-1-ac4-
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
11 Wth J' .039
-5910
Contractor City of Fe Collins Sales Tax #
Are you paying taxes here or by report?
Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
Yes ❑ No
Is this a residential or commercial project? A Residential ❑ Commercial
If residential, is it: ,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 ANo If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
Subcontractors: List the company name or City of Ft Collins license #
Electrician
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-
ru�u�