HomeMy WebLinkAbout936 Sandy Cove Ln - Applications/Water Heater - 06/26/2018Cf y o3 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 XWater 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 # e I o o S o I ib Date
For ofI"iee use only
)ob Site Address (required, Value of Construction (labor, materials, profit)
63(e S edLC
Property Owner Name Address Gty/State Zip Phone
7Li-L23-S
Applicant Name _ Address U City/State Zip Phone
lam 6 A fi96 a 1 503 z
Contractor Address G /State Zip Phone
NO
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Contractor City of Ft Col s Sales Tax l 'Are you pa ng taxes here or by report? Here ❑ Report
Sales lax number isrequrredbyall conbadnrs Are you paying with your trust account" ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it Single Family Detach ❑ 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 budding SO years of age or morel ❑ Yes ❑ No If yes, you may near/ to contact Hiskanc Preservabon
If this is for a demolition permit, what year was the building constructed?
f r
Description of wo
*If lawn spnnkler/backf ow preventer, must list licensed plumber If first-time A/C, must list licensed electnaan
Subcontractors List the company name or City of Ft Collins license #
Electnaan 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
ApplicantVA�Pnnt Name Signature Date
U
Rensron date ZVM17
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