HomeMy WebLinkAbout308 Mae St - Applications/Water Heater - 03/22/2018From
03/14/20143 07:43 #940 P.001/001
Planning, Development, & Transportation Services
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 0 Sewer Line ❑ Photo-voftaic
❑ Ventilation`�Nater 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 # 8(Sm(032�5 Date _��\��\g
For oft a use only
lob Site Address (requ/red) Value of Construction (labor, materials, profit)
Prope4 Owner Name Address City/State Zip Phone
- 3
Appli t 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
Sales tax number is required by alb cnrrrrartas. Are you paying with your trust account? ">'es ❑ No
3s�ns
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: Ingle Family Detach ❑ 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?
Description of wo cl'i� o
*If lawn sprinlder/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Me company name or (7ty of Ft Collins license 0
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:
Print Name: C1Nfcl.Q.. CC0rrr, signature �Q .-D +'L�cs Date
Revision date 26MI7