HomeMy WebLinkAbout2413 Poplar Dr - Applications/Water Heater - 01/19/2017JAN/19/2017/THU 01:28 PM
FAX No. P, 006
Fort Collins
Planning, Development 8t 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 m(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 # �) 0 a U4 Date H q _l �
Aor ofte use only
Is this a residential or commercial project? ErResidential ❑ 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 (expiai
Is this building 50 years of age or more? ❑ Yes WNo Ifyes, you mayneed to ca17tac7 Histo»c Freservat✓on
If this is for a demolition permit, what year was the building constructed?
!f prior to 1975, you w/ll need an asbestos assessment to submit with this application.
Description of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L1st the company name or City of R Colllns license #
Dectician Plumber MechanlCal 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
Print Name: �Signature
Date_ 1119111