HomeMy WebLinkAbout1609 Maple St - Applications/Water Heater - 01/09/2020City of Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins, CO 80524
Phone 970-41616-2740 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 # - '1 `1 � U6CG_�T-D
For ofce use only
Date 1 f2/A17'1'9 /R/acp--o
Job Site Address (required)
Value of Construction (labor, materials, profit)
1609 Maple Street
5 5 S ,
Property Owner Name Address
City/State Zip
Phone
Jeremiah Klingman 1609 Maple Street,
Fort Collins, CO 80521 USA
(207) 461-2227
Applicant Name Address
Citv/State Zip
Phone
4600 Innovation Dr. Suite 102 FortCollins 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' eReport
Sales tax number is required by all contractors.
re you paying with your trust account?
EIYes ❑ No
52310
Is this a residential or co mercial project? 13 Residential El Commercial
If residential, is it: El Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hote otel ❑ Medical office ❑ Office
❑ Restaurant ❑ Other (expl3jrq
❑ Duplex
❑ Retail
Is this building 50 years of age or more? ❑ Yes 0 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
*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 p 56 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: MUM
n r �1 •� 12/11/19
Print Name: � 1 0 II Y � lU0 Signature Date