HomeMy WebLinkAbout2715 Saddle Creek Dr - Applications/Water Heater - 04/13/2018:FCity of Planning, Development, & Transportation Services
ort 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 appii 11e formation on the application. Incomplete applications will not be accepted.
Application # 1 Date L4' IS_
For of!"rc� use only
Job Site Address (required)Cralue of Construction (labor, materials, profit)
71-{-Sµc rb� k l._ems/( i,—
Property Owner Name Address City/State Zip Phone xa
Applicant Name Address City/State Zip Phone
Contractor Address City/Stat Zip Phone
l��&23.3 � 71J30� y7 z�
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? 04fiere ❑ Report
Sales tax number &rWdredbyall mnbactws .4-,7 3 Are you paying with your trust account? ❑ Yes <"o
Is thisa residential or commercial project? 'C Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Cmdo/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 SO years of age or more? O Yes ❑ No If yes, you may need to contactHistadc Preservation
If this is for a demolition permit, what year was the building constructed?
Desaiption of work y
*If lawn sprinkler/baddlow 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 f/ 22 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: � c4,,y _ Signature _ _ Date — ^�
Revlsim date 2Bno1 7