HomeMy WebLinkAbout707 W Mountain Ave - Applications/Water Heater - 02/06/2020'City of Planning, Development & Transportation
Y 281 N. College Ave P.O. Box 580
Flirt Collins 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 # R2601 Sr76 Date lc�� G 2020
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State GO Zip
Phone 970
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Applicant Name Address
City/State Zip
Phone 979
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Contractor Address
City/State Zip
Phone 770
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? X 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 mayneed to contact HistoricPreservadon
If this is for a demolition permit, what year was the building constructed?
Description of work
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*If lawn sprinkler/bacldlow 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%'fZ- %I0 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:
Print Name: /���'�� �� Zl Signature �� Date 6, - %�,40