HomeMy WebLinkAbout5409 Parkway Cir E - Applications/Water Heater - 02/14/2017/ 14 / W 74-201 T1 V AIM PS;0M-
TO:19702246134 FROM:7W494E35d34 T-699 pP.9/008 F-218
`ky°folt�ns
Planning, Development IN 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.
Application # * wo I rerrr) 'I ' o ;o m u/'l t e— r
For ohw7oe use onlyl i nn _7 D
Sob Site Address (mquired)
Value of Construction (labor, materials, profit)
5 &tktuau C-r E.
411I0$
Property Owner Name Address
EverhGz l
City/State Zip
'r
Phone
r►
E r nl lips 9b,525
27-
Applicant Name Address
Fad Coll wn--. Heating and Air 209 Commerce
City/state Zip
Dr. #4 Fort Collins- CQ 80524 4Q70)
Phone
-Anr%_147R
Contractor Address
Gty/State Zip
Phone
FoTt Collins Heating d 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
.%LVtax number isregWredbya#contadors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? ®Residential ❑ Commercial
If residential, is it: O Single Family Detached ❑ Condo/townhome (single family attached) U Duplex
O Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church 0 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? U 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 prior to 1975, you wi//need an asbestos assessment to subm/t with this application.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Me company name or City of Ft Collins Acense #
Beco aian� Plumber Mechanical 141309 Roorer
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. 1 know that a
permit is not valid until it has been paid and issued.
Applicant;
rt: ��`�r�aW bale 2//y/l7
Print Name:_ _Angela Morrow Signature