HomeMy WebLinkAbout208 Mae St - Applications/Water Heater - 03/28/20171124/2 �4-201�11:56AMAMFRVRT TO:19702246134 FROM9W4JaAV07234 T-9T0 P.005/OQ5 :F-8305
City.of Planning, Development 8c Transportation
281 N. Coege Ave
FoCollins Fort Collins, CO 80524.0. Box 580
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) 0 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 #_ J 17Q I \J(14 Date c-3 -ag• n
For orrice use only
Sob Site Address (repuoied)
Value of Construction (labor, materials, profit)
v8 Mae sic.
Property OWner Name Address
M aU L-� 31Z2 TW iesiy) �i
City/st Zip
kr s 62:�52L -
Phone
t -1 G5
Applicarit Name Address
City/State Zip
Phone
5
Contractor Address
City/State Zip
Phone
Fort Collins Heatine and Air 208 Commerce Dr. #4
Fort Collins CO 80524 970
484-4552
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here
❑ Report
&Mtftarmumbrresimuliedbyall ccnlrad m Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? M Residential ❑ Commercial
If residential, is it: O Single Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
❑ 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?
Ifpvror to 1975, you wi/l need an asbestos assessment to submit with this application.
Description of work
C
*If lawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: Z& the company name or Qy of Ft Collins license #
Electrician Plumber Mechanical H1309 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.
Appli®nt: % nJ�( 1�/'err/ )
Print Name: Angela Morrow Signature '/ r (Jl,�r DateJI�I