HomeMy WebLinkAbout513 Nokomis Ct - Applications/Water Heater - 01/27/2017Planning, Developmant &7mnsportatior.
281 N. College Ave P.O. Box 59n
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-% R.E'°'COUNTER PER119M ONLY
Tt:is application is to be used to apply for the following pe-mits only (check all that apply). ❑ Air Conditiarin1;
-i U�,n:oiition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter I:] Gas Log
I FIenting Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
i Vanilla doll ater Heater I] Water Line ElWood/Pellet Stove (must be EPA certified, provide make. modal :i.isi
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Complete all app)lcable infomfation on the application. incomplete applications will not be accepted
Application e) �100 3C1-7 Date
rvr office use only - - - --- -- --. -_- _ -,
?ob SEts Address requlred)
Value of Construction (labor, medals, p o t)
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Property Owner Name ��
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Address GtY/State t��p77 phone y
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City/State Zip Phoi+e
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i Gnnractor
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Contractor City of Ft. Collins Sales Tax #
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Are you paying taxes here or report? ❑Here 9peport
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Are you paying with your trust account? 'ryes CI No
;:t:: rs+ eunAb risraquired
Is ti+is a residential or col dal project? 21119idential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) El Uuplex
❑ Multifamily (apartment) ❑ Garage
if commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Reiail
❑ Reslauranit ❑ Other (explain) - - --
'; rN.; building So years of age dr more? ❑ Yes ❑ No If yes, you may need to contact HlstorlcPreserv,76t+n
h' i-his is for a demolition permii;, what year was the building constructed? -.--- --- -- - - -- -
c i. �r to J973, you will need an asbestos assessment to submit w1th fills application.-
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()ascription of work OUL* -S _-
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If lawn sprinmer/backflow preventer, must list licensed plumber. if first-time A/C, must list licensed electridan.
S::.contia ctors: ust Me company name or Qty of Ft Collins license
Plumbeir____- Mechanical Roofer-____—_ ._- OUier
acknowledge that i have read tills application and state that the above infonnalion Is complete and cortect. 1 cgrae ra
,,;:p iv with all requirements contained herein and city ordinances and state laws regulating building construction. i know that e
..mu` lit is not valid until it has been paid and issued.
Printflame_ /!��/'1 �aYj �Qllre ,�natvref ��'� date