HomeMy WebLinkAbout721 Eastdale Dr - Applications/Water Heater - 04/03/2017117120W07-ZOR01r:d3AN1 FROMF TO:19702246134 FROM: lii& %27234 T-099 P-DATT F-264
af Planning, Development & Transportation
Cl.} 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 #.
Ahr offm use only
Date
]ob Site Address (iequ#ud)
Value of Construction (labor, materials, profit)
721 Eastdale Dr.
$1,676
Property Owner Name Address
City/State Zip
Phone
Mavis Johnson 721 Eastdale Dr
Fort Collins 80524
416-7904
Applicant Name Address
Fort Collinq Heating and Air -20R Commerce Dr.
City/State Zip
#4 Fort Colling- CO 80524
Phone
(970) 305-347R
Contractor Address
city/state Zip
Phone
Fort Collins Heating 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
SMN annwnberisre+v~byallmntraftV
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? IKResidential ❑ Commercial
If residential, is it: RSingle Family Detached ❑ 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?
ff prior to 1975, you W11 need an asbestas atsseRsment to submit with thls app/Icavbn.
Description'of work
*If lawn sprinlder/backtlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subc ontractOrs: L/st the company name or oty of R Collins /!tense #
Electrician Plumber Mechanical H1309 Roofer
Other
I hereby advaHAedge 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: Angela Morrow Signature
Date l �` 7