HomeMy WebLinkAbout1437 Regency Ct - Applications/Water Heater - 02/07/2017FEB/07/2017/TUE 01:18 PM FAX No. P.002
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 Cl 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.
Application # b 11 b o 5 N Date
For offxv use only I lso
Job Site Address IValue of Construction (labor, materials, profidt�o
�'o. f-Ci �
Property owner me Address City/State Zip Phone
?aA I W6+ same as < bc,v'-e, gWW -10y'd 5a
rpilcant Namfe� _ Address City/State Zip Phone
Contractor Address Gty/State Zip Phone
Rd
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
safes ray number 'is�4uiredbyancw,tract= Are you paying with your trust account? ❑ Yes ❑ No
9
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 ❑ Hotel/Motel ❑ Medical office ❑ Office 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may naed tv contact H/storic 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 w/th this appl/ration.
Description of work
N
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or City of Ft collies lhense #
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,
Applicant: (
Print Name: Kai jlo Signature Date KI—