HomeMy WebLinkAbout3933 Celtic Ln - Applications/Water Heater - 12/27/2016DEC/27/2016/TUE 08:59 AM
FAX No,
P. 003
Fort 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) O Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler b Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation VWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
e2lApplication #
For office use ony
Incomplete applications will not be accepted.
Date 21 � 4
Is this a residential or commercial project? ErResidential ❑ Commercial
If residential, is it: 0 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 (explai
Is this building 50 years of age or more? ❑ Yes NrNo if yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you wi/l need an asbestos assessment to submit with this application.
Descriotion of
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electr1cian.
Subcontractors: Llst the company name or C/ty of Ft Collins llrense ,#
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 hereln 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: e � ►�� Signature Print Name:A6 J1 � g mgxr._ pate i 2) 2 %LI LL__