HomeMy WebLinkAbout300 Parker St - Applications/Water Heater - 01/17/2017JAN/16/2017/MON 08:04 AM FAX No. P.003
City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
®!r6t Collins Part 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 ❑ Oas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable jInformation on the application. Incomplete applications will not be accepted.
Application # ,� I Date I I V
For office use only
Job Site Address (requlmd) Value of Construction (labor, materials, profit)
Y L11z &OZ15
A1
Property Owner Name Address Clty/State Zip
Phone
Applicant Name Address CIty/State ZIP Phone
Contractor Address City/State Zip Phone
Contractor City of Ft Collins Sales Tax #
_WesUrn �t21e is regv� I _tied by all mnbactors
Are you paying taxes here or by report? ❑ Here d Report
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ('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 O Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explaiI
Is this building SO years of age or more? ❑ Yes &f No Jf yes, you may need to contact Hrstorlc preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior !o 1975, you will need an asbestos assessment to submit with this applkal on.
Description of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-Ume A/C, must list licensed electrician.
Subcontractors: Ust the company name or City of Collins //tense +P
Electrician Plumber
Mechanical Roofer
Other
I hereby acknowledge that 1 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: ,c ,,,u���Signature44w��
pate ' 1 1U 1-j