HomeMy WebLinkAbout309 S Shields St - Applications/Water Heater - 07/02/2018Planning, 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 ❑ 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 #
For office use only
Date
Job Site Address (required') Value of Construction (labor materials profit)
-SW t LV r.
Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/Sta a Zip Phone
Contractor Address II City/State Zip Phone
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Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is requved by all contractors Are you paying with your trust account? XYes ❑ No
Is this a residential or commercial project? 11WResidenbal ❑ 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 Histonc Preservation
If this is for a demolition permit what year was the budding constructed?
Description of work d G/ftto�r �"Z.
*If lawn sprinkler/backflow preventer must list licensed plumber If first-tlme A/C, must list licensed electrician
Subcontractors List the company name or City of Ft Collin license #
Electrician Plumber /kPZS 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 -/-� -
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Print NameC�fr� -4GP—Signature� pate d -2s -/8
ReAslon date /WO17