HomeMy WebLinkAbout5609 Cardinal Flower Ct - Applications/Water Heater - 01/09/2020Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 # Imo`" Date
For ofce use only �^
Job Site Address (required)
Value of Construction (labor, materials, profit)
5609 Cardinal Flower Court
b3 o 3 b
Property Owner Name Address
City/State Zip Phone
Lori Wold 5609 Cardinal Flower Court, Fort Collins, CO 80528 USA (970) 222-9269
Applicant Name Address
City/State Zip Phone
G 4600 Innovation Dr. Suite 102 Fort Collins CO 80525 970-399-9940
Contractor Address
City/State Zip Phone
Benjamin Franklin Plumbing 4600 Innovation Dr. Suite
102 Fort Collins, CO 80525 970-399-9940
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by allcontracto/
Are you paying with your trust account? ❑ Yes ❑ No
52310
Is this a residential or cor�friiercial project? ff Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townho a (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotep tel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? ❑ Yes No If yes, you may need to conbctHistoric Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Gng4 — ln1 ,t _ �� �O LA/1, >A) J � WE Lt QCA
1 Yli d G cr tM 4AA-
*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 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.
Applicant: C l,� jl pp `t ,� / d� 12/4/19
Print Name: C // Gdl Signature