HomeMy WebLinkAbout1550 Blue Spruce Dr - Applications/Water Heater - 03/23/2018)2O
at yof Planning, Development, & Transportation Services
Fo't 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 ❑ 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 # b l o� U l 'l t2—
For office use only
Date 3 —Z 3 —(ir
Job Site Address (required) Value of Construction (I bor, materials, profit)
2f570
Properly Owner Name Address City/State Zip Phone
I
Apple nt Name Address City/State Zip Phone
2 I / � C-
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here deport
sales tax number isrequired/q'ai�,con1�fo tractors. Are you paying with your trust account? ❑ Yes 9
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: ❑ S.ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
H 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 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 Cl of Ft Collins license #
Electrician Plumbernfi-,WoMechanical 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
Print Name: 12/1,J L_ 6�a 4-- Signature fyJ�—� Date
1k377
Revision date 2/6/2017