HomeMy WebLinkAbout2625 Platte Pl - Applications/Water Heater - 12/05/2016Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
��r-$ Collins Fort Collins, CO 80524
Fort Phone gins, CI 8052 Fax 224 6134
OVER-THE-COUNTER (PERMITS ts only (check all aONLY
I` O Air Conditioning
This application is to be used to applyfollowing
❑ 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 ` 5 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 #
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For otl% use only Date +
lob Site Address (required)
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Property Owner Name
Applicant Name
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Contractor
Value of Construction (labor, materials, profit)
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Addresss�/ LIty/Sm �
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Address City/State
Contram:far City of R. Collins Sales Tax #
sales fax number is required by all cunt actors.
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Address City/State
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Zip a l)5,� Zo Phone 0 -70
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Zip Phone ct O
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Zip L' 51 Phone "i -1 u
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Are you paying taxes here or by report? '&Here ❑ Report
Are you paying with your trust account? 17' Yes �bNo
Is this a residential or commercial project? PPResidential ❑ Commercial
If residential, is it: �ingle 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 If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit w/ffi this application.
Description of
*If lawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of R Collins license #
Dectician 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 (mow that a
permit is not valid until it has been paid and issued.
Applicant: j �i i)"t b ti' ! (_I i� J L /Lti �`� i ,'l f �. I o / (A
Print Name: I Signature Date