HomeMy WebLinkAbout1513 Crestmore Pl - Applications/Water Heater - 02/22/2017City of Planning, Development & Transportation.
281 N. College Ave P.O. Box 580
F®rt CoWns 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 JtWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be E'PA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # V� 1 g0083,s Date 2 2Z - I i
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property ner Nam Address
City/State Zip
Phone
pplicant N me Address
Ci /State Ziip
Phone
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Con ra r Address
Zip
Phone
N/State
Contractor City of I Collins Sales 14x#
Are you paying taxes here or by report? ❑ Here
Zr Report
Sales tax number is required by all contactors.
Are you paying with your trust account? 0 Yes
❑ No
Is this a residential orrmsiluldfamily
mercial project? ❑Residential ❑Commercial
If residential, is it..ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
(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 (explain)
If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you w/ll 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 . 3 1 Mechanical Roofer Other
I hereby acknowledge that I have read this appllcation 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: Signature Date