HomeMy WebLinkAbout2162 Chandler St - Applications/Water Heater - 12/31/2019�City of t CoRgans
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVERmTHE-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 W 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 # FI 1I % Z-E) Date L0JJAJIp
Foroff1ce use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
MIN 01hanS
-319H s0
Property Owner Name Address
City/State Zip
Phone
Ion W11 Alin.) t1hnnAjs
S 80JR&
Q
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
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Contractor City of 4. Collins Sales Tax #
Are you paying taxes here or by report?
1A Here ❑ Report
Sales tax number lsrequired byall contractors
Are you paying with your trust account?
Yes ❑No
Is this a residential or c mmercial project? 0 Residential ❑ Commercial
If residential, is it: I 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 If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
. a idwn spnnrier/oacKriow preventer, must list licensed plumber. If first-time A/C, must fist 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.
Print 0— iII 1 H IlSignature &J _Jnl'�-��