HomeMy WebLinkAbout2218 Stetson Creek Ct - Applications/Water Heater - 12/29/2016City of
F`rt 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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation KWater 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 # i�!—)l b0i77
For office use only
Date
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Job Site Address (required)
Value of Constructio7
(labor, materials, profit)
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Property Owner Name Address
City/State
Zip Phone 'Z 7
Applicant Name Address
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Contractor Address
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Zip Phone
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Contractor City of Ft. Collins Sales Tax # 70-gZ7j5_Are you paying taxes here or by report? ;ff 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? if Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached P3 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 OrNo 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 Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above
comply with all requirements contained herein and city ordinances and state lad
permit is not valid until it has been paid and issued. Z--\ /
Applicant: � C
Print Name: Signature
mation is complete and correct. I agree to
ulating building construction. I know that a
Date 1 Ci — Z � - 6