HomeMy WebLinkAbout314 E Mulberry St - Applications/Water Heater - 05/17/2018City of Planning, Development, & Transportation Services
Fort 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 12f 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 # ()1�63W(A Date
For office use only HIM
Job Site Address (required) Value of Construction (labor, materials, profit)
3iq E. 10oIbQ�r AL-,Q Pcy i,ns Co
Property Owner Name Address City/State Zip Phone
14 6FE . Mi Ilvkiv A-ve ro�_k G 906(�
Applicant Name Address City/State Zip Phone
- (l-0-✓1 q 1 Z 1�'Z ✓Sr-.s� r-c, i �y�� i�f �' go-7-7-4/
Contractor Address itv/State Zip Phone
o CL, 1-10 A C o 01 �Q �- r wte� I � � i i� � Po � ZS 9" 2 3
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? .8 Here ❑ Report
sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes 0 No
Is this a residential or commercial project? H Residential ❑ Commercial
If residential, is it: 0 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 ihS1a(f SO au/i'vin yiolky, 14ecf-ey
*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:
Print Name: �&_av1 C7��2�e �I Signature Date
Revision date 2/6/2017