HomeMy WebLinkAbout1526 Mathews St - Applications/Water Heater - 02/20/2018From,
02/12/2018 10.41 #907 P.001/003
-atia3n
Clty of Planning, Development, & Transportation Services
,art Whns 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-vollaic
❑ 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 # ?)1`b01O U3 Date g ?A � ICb
For of a use only
lob Site Address (required) Value of Co a on (labor, materials, profit)
.30
Property Owner Name Address City/State Zip Phone
I-
Appliiant Name Address City/State Zip Phone
Contractor Address City/State Zip phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report.? Mere ❑ Report
Saks tWnumberIsnq&ftdbya#m7ftdc . Are you paying with your trust account? WYes ❑ No
BW205
Is this a residential or commercial project? kalesidential ❑ Commercial
If residential, is it: i4csr►gle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
[I'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 o No lfyes, you may need to contactHbs c jlres rabon
If this Is for a demolition permit;, what year was the building constructed?
Description of work
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed elecbiden.
Subcontractors: Lit Aye company name or Oty of Collins /Iaense 0
6ectr1dan Plumber Mechanical Roofer other
I hereby acknowledge that I have read this application and state that the above information its 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: ^ \
Paint Name:�y�tt . cw.&� Signature Czs&&aNt" Date
Rv"m date a saot7
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