HomeMy WebLinkAbout1331 Patterson Pl - Applications/Water Heater - 03/26/2018Mar 26 2018 03:54PM HP Fax 9706130826
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ci'? of Planning, Developmen4 & Transportation Services
Fps±Cottins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 97DA162740 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 n the a Ncatlon. Incomplete applications will not be accepted.
Application # I 6� Date 30101 i 8
Ue
only
lob Site Address (req d) Value of Construction (labor, ma als, profit)
Property Owner Name Address City/State Zip Phone
(S
Applicant Aame Address City/State Zip Phone
Contractor yy. Address City/State Zip Phone
IC
Contractor City of R, Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
SAW Lay numberlsraw#edbyaffcm&actom Are you paying with your trust account? 9k Yes ❑ No
Is this a residential or commercial project? Wesidentiall ❑ Commercial
If residential, Is It: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Hank ❑ Bar ❑ Church ❑ Hotei/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 Hztadc preservation
If this is for a denrolitim permit, what year was the building constructed?
Description of work Imp am III enduffle)IF
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subconbactors: L& the company name or city of Co#h7s lkanse ,#
Bectriclan 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
penidt Is not vagd until It has been paid and Issued.
Applicant: ' !' 1 l �U I 1 w LV SignId Is A A Date
Print Name Lll!t*
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