HomeMy WebLinkAbout161 W Mountain Ave - Applications/Water Heater - 02/16/2018�t Collins
of
Planning, Development & Transportation
281 N. College Ave P,O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 0 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all appli able 'n ormation on the application. Incomplete applications will not be accepted.
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Application # f-L? 3/ �P- Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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1�tI$&o'01)
Property Owner Name Address
City/State Zip
Phone
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CV � C'CjL_
0102N-611.3H
Applicant Name Address
City/State Zip
Phone
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Contractor Address
City/State Zip
Phone
(SQJ V 56S WOM,
Contractor City of Ft. Collins Sales Tax 4
Are you paying taxes here or by report?
❑ Here St Report
sales tax numaer is required by all contractors.
1C'13 1 I
Are you paying with your trust account?
Erl'Yes ❑ No
Is this a residential or commercial project? P Residential ❑ Commercial
If residential, is it: Single 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 50 years of age or more? ❑ Yes VI No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prii9r to 1975, you will need an asbestos assessment to submit with this application.
Description of work W/IGt(t 2 <] O-itADh, n(krygt:l pig W i AC K)Ick,irek_S
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: UFt the company name or City of Ft Collins license #
Electrician_. Plumber__________.,-__-_- Mechanical-___
------..._— Roofer.____---------- Other
-
Applicant: 1tn �1 I ' I I / VV
Print Name:( W� I>y� 01 Gtl1� signature . •! �"n� w �- __ Date Z I Iy