HomeMy WebLinkAbout3737 Landings Dr - Applications/Water Heater - 03/14/2018r
City of Planning, Development, & Transportation Servic- es
Ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134 L
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 mffar ation on the application. Incomplete applications wi I not be accepted.
Application # Date -6
For offs& use only
Job Site Address (requireqV Ip Value of Construction (labor, materials, profit)
3737 A7. F/. (0 H525 1513 e)
Property Owner Nam19 Address City/State Zip Phone
u2 � MCZc� `>< t"a �ic� 47525 303 _44- 0S3
Applicant Name U Address _ City/State Zip Phone
t'� 't v i .23D � ? l(1 &,n C°U e atp 3 ,?W16 5
Contractor Address City/State Zip Phone
� 2 ) �. 61l 363,Ze0-S'705
Contractor City of Ft. Collins Sales -lax # Are you paying taxes here or by report? Here ❑ Report
sales tax number is required by all contractors Are you paying with your trust account. ❑ Yes ❑ No
Is this a residential or commercial project? lResidential ❑ 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 ❑ 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 Ilailm
5 L
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
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: 0al11we 1' `� vW�✓L l / Date 2(Prini Name: Signature
Revision date 2/.12017