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HomeMy WebLinkAbout2937 Bozeman Ct - Applications/Water Heater - 01/24/2017City of 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'0 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable Information on the application. Incomplete applicatlonsiw not be accepted. Application # L� ���� Date I / 7 For office use only Job Site Address (required) 2a 3 •� Owner Value of Construction (labor, materials, profit) Address City/State Zip a OG 2 to Phone el Applicant Na Address \ City/State n Zip C- C I531 Phone 10 r' l �JV 1'-I<` jtj7)l.i�-'t�r•�`( r�cL-i_. I.i:•l.;_Z-�.(L:.-c� Contractor Address City/State Zip O L' 5 51 Phone ql -� J Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? '1Here ❑ Report Sales tax number& required byall mnaad'um Are you paying with your trust account? ©'Yes 19�No Is this a residential or commercial project? PResidential ❑ Commercial If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑Duplex -0 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 pr1or to 1975, you will need an asbestas assessment to submit with 64is applicalyon. Description of *If lawn sprinlder/back iow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or Lity of ft Collins license # Electrician 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 know that a permit is not valid until it has been paid and Issued. 1 \ 1 Applicant: I J'i�.r Vv I ( ;�T L/. / �'�111 1 \'� Date I 1 L Il Print Name: I Signature