HomeMy WebLinkAbout2431 Cheviot Dr - Applications/Water Heater - 01/03/2020I., -Ft:ity oT Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Services
_ 281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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 Un``i��t,,P� Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ VentilationWater Heater ElWater Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)PNN
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application Uft)(EG. Date ` �'—
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
73y
Property Owner Name Address City/State Zip Phone
A(uij
Applicant Name Address City/State Zip Phone
8G5 y�v�cc 97
Contractor Address City/Stat Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Mere ❑ Report
Sales tax number is required by allconbadois Are you paying with your trust account? ❑ Yes 0
Is this a residential or commercial project? 4 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 ❑ No Ifyes, you may need to contact Histmic Preservation
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: List the company name or 0Y of Ft Collins license #
Electrician Plumber 673 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: �� A
Print Name: ��rv✓��ivt-dry_ . Signature
Revision date 2B/2017