HomeMy WebLinkAbout707 Sandpiper Pt - Applications/Water Heater - 01/02/2020City of Planning.. Development, b Transportation Services
/-Fort Collins Community Development & Neighborhood Services
m 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 Unit ❑ Lawn Sprini -- ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ® Water Heater .Hater Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application #4oce
.�...,...,
Incomplete applications will not be accepted.
Date 'I q' 1 1
Job Site Address (required) Value of Construction (labor, materials, profit)
207 5c. ) e r 0 In )i- Fdl-A �a _r 1"4 P05-A S 76 a 2 d- 5_3 2 G o
Property Owner Name Address City/State Zip Phone
/h C� 1 07 SG o,n//- /Zn J -5` Sr/70-537
Applicant Name Address City/State jJTZS Zip Phone
Contractor Address City/State Zip 8052s' Phone q7o -
LMM .f i oo �' i 02 3 `l94'
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ikReport
Sales tax number is required by all contractors: Are you paying with your trust account? Ayes [► No
�MZD
Is this a residential or commercial project? �Kl Residential ❑ Commercial
If residential, is it: •53 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 p[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 S a 11 h a I V a s t-/ o )-_ rsTa s
*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 R Collins license #
Electrician PlumbeAP ELM 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: �2� i�+lict� Cabin
Print Name iignature _ Date
Revision dale 4I62017