HomeMy WebLinkAbout3500 Carlton Ave - Applications/Water Heater - 07/02/2018Planiging, Development StTransportation
.I t y of � 281 N College Ave P O BOX 580
• � Fort Collins, CO 80524
Phone 970-416-2740 Fare 2245134
OVER-THE-COUNTER PERMITS ONLY
This eck all that apply) � Air Conditioning
application !s to be used to apply for thO foliow)ng permds only (ch
E7 DCyUlihon (into/Or non-structural) ❑ Electrical Alteration (not service change) CI Gas Lighter ❑ Gas Log
r' /eadng U Lawn Spnnider ❑ Mobile Home replacement ❑ Ropfing la Sewer Line 0 Photo -voltaic
IJ Vendlagon Water Heater ❑ Water Line ❑ WOod/Pellet Stove (must be EPA certified, provide make, modal and
manufacturer)
Complete all applicable rnfon cation on the application Incomplete applications will not be accepted
Application #
� � (n 5111 Date
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Foroftrce use only
job Site
Address
Aupll f 'r Address
VwZ�e
Ooritractor,� TA
Address
Contractor City oC FL Collins Sales Tax #
is tr� nunrbar rs r94urred by amnuacwrx
Is dils a residential
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Value of Constmcc}ao'n/ (moor,
ip
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City/Staje 7Jp
CIiY/91at2 ?IP
profit)
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Phone
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Phone
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Phone
Are you pti igng taxes here or by report? ❑ Here' kel
Are you paying with your trust accot)nt? 'Y-Yes d No
p commercial p Duple c
Awnhome (single family attached)
If res en r LI MuitlfarYti[y (apartment) 'p Garage
Ir commercal, is it ❑ Batik ❑ 13ar ❑ Church 13 Hotel/Mctel ❑ Medical office ❑ Office 0 Retail
❑ Rest4urAnt 0 Odle'r (explain)
Is thi$ Mudding so years of age or more? U Yes [] No Xfyeg you mayneed to canted HlstorlcPreservadon
If this is for a demolition permit, what year was the building constructed?
?r piiur try x975, you wid need an asbestos a5sp mmegt tv submit d't thts application
Of,
_ rr lawn sprinkler/backflow preventer, must Ila licensed plumber If first-time A/C, must list licensed electrician
subcontracto"s UstibeComPanynamacratyofftColllnslkense# Other
tLclrlciair_
Piumbe, Mechanlcal Roarer
r hereby acknowledge that I have read this application and state that the above Information is compiebe and correct I agree Co
i comply with all requirements contained herein and city ordinances and state laws regulating building construction i know that a 1
permit is not valid until it has been paid and Issued A ,
l APPOCant &Je
Print Name Is A J