HomeMy WebLinkAbout2514 Owens Ave - Applications/Water Heater - 06/29/2018City of t Planning, Development & Transportation
281 N. Coege Ave
F ` Collins Fort Co I ns, CO 80524 P.O. Box 580
Phone 970-416-2740 Fax 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 #?2k2ib1(P4q Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Nami
Address
City/State Zip
Phone
z
pplicant N me
Address
Ci /State Zip
Phone
c.
1
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on r
Address
Ci /State Zip
Phone
d
o
oUG N.
ws
Contractor City of Ft. Collins Sales x #
Are you paying taxes here or by report? ❑ Here
Rf Report
Sall x 1 Z is required by all contractors.
T
Are you paying with your trust account?,RJ Yes
❑ No
Is this a residential or merciai project? O Rsdential ❑ Commercial
If residential, is it: Ingle Family Detached Ff 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 Histor/c Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*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 �BAMechanical 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: Z
Print Name: ffiPV_ N1 Or Signature �-�/'1 Date z J Q) �—