HomeMy WebLinkAbout2002 Fisch Ave - Applications/Water Heater - 01/23/2017- 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) ❑ Gas Lighter ❑ Gas 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 information on the application. Incomplete applications will not be accepted. 01A
Application # I1 0� 00.po-I41I4 4, K0i'1ti - Gift%;V-r �1'ece(�Y� > t
Date
For ofte use only
Job Site Address (required)
1CC2 Ylsch Dr. V10
Value of Construction (labor, materials, proflt)
It I I ,';"CI
Property Owner Name
T i I f A s.
Address CI Zip
F, Da. -Ave. Izx Lierslq
Phone
11AZ.-(rSL'z
Applicant Name
Fort Collin,; Heating and Air
Address City/State Zip
20R Commerce Dr- 94 Fort Coiling CO R0524
Phone
(970) 301-1479
Contractor
Address City/State Zip
Phone
Fort Collins Heatine and Air
208 Commerce Dr. #4 Fort Collins CO 80524
970 484-4552
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number isrequlredbyall contracrors Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
19 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 Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975 you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backfiow 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 H1309 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.
r i�Applicant:
int Name: Angela Morrow Signature Y �V%
Pr ( "�L' Date