HomeMy WebLinkAbout1821 Beam Reach Pl - Applications/Water Heater - 01/26/2018Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main 970 416 2740 Fax 970.224 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 5KWater Heater ❑ Water Line D 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 # b IZ) 00 `1 q D Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
1 Sal Beam fear.!. pi 15a 8
Property Owner Name Address City/State Zip Phone
Efni Ro ieal eArrir a "d l; GO 05D -697-1
Applicant Name Address City/State Zip Phone
3e ;w dil&aM WAk.4osix wa 80S35 70-a -
Contractor Address City/State Zip Phone
G661 Gv Zi tsrne Se iZz-S y 170-8i1?--9Pq8
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 9 Report
Sales tax number xmqunedbyall contractors Are you paying with your trust account? Yes ❑ No
M-31v8s M)
Is this a residential or commercial project? :Residential ❑ Commercial
If residential, is it: 5kSingle 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 SG years of age or more? ❑ Yes;R.'No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed
Description of work Replace, e x vv ate ei Aea4ar w4,k SAS a l a
BTU Y Al m ,(g hz�f c- Vrn.i- w r ) fAAC%
*If lawn sprinkler/backflow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or City of Ft Collins license #
Electrician Piumber 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:
Print Name: Paaic La Signature C :6t� Date
Revision date 2512017