HomeMy WebLinkAbout733 Langdale Dr - Applications/Water Heater - 04/10/2017 (2)From:
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Collins
03/31/2017 09:48 #558 P.001/002
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
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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 O 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.
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For office use only
Date -7
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner IoAe Address
City/State Zlp
Phone
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scant Name Address
City/State Zip
Phone
Contractor Address
City/State Tip
Phone
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
If Here *Report
Sales tax number is required by all contractors.
Are you paying with your trust account? )tYes CI No
Is this a residential or, meraal project? ❑ Residential El Commercial
If residential; Is It: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartrnent) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other(explai )
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 building constructed?
If prior to 1975, you will 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 d'
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: ^. 3
Print Name: ` \ILCO\Q %6XTY-% Signature s.." $2164 Date /