HomeMy WebLinkAbout354 Brinn Ct - Applications/Water Heater - 07/17/201805/14/2015 21:21 1 1 PAGE 01/01
Cityof 1j. Planning, Development, & Transportation Services
t Collar$ 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) ❑ Gar: Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Irne ❑ 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 # � \ 0ySU L44 Date ? I le� 1 q
For ofte use only
]ob Site Address (required) Value of Construction (labor, materials, profit)
S�� f utu,C 5f-4-61lr�5r6 US IS- T/2-4el-8 s
Property O r Na Address City/State Zip Phone
A"' nt NaIne f Address City/State Zip Phone
CbMactor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here diqeport
S9/e4taxnum requlredbyall cantraciws. Are you paying with your trust account? ❑ No
Is this a residential or commercial project? ,1�1ReSidentlal ❑ Commercial
If residential, is it: ,<Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Muhifamily (apartment) ❑ Garage
If commercial, is it: C] Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (exp)aln)
Is this building 50 years of age or more? ❑ Yes o Ifyes, you may need to contact Historic Preservaft?
If this is for a demolition permit, what year was the building constructed?
Descripti n of work
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*If lawn sprinkler/baddlow preventer, must list Ik= . sedplumber. If first-time A/C, must list licensed electrician.
subcontractors: List the company name orCky of Collins Ikeense 0
HecVlclan� Plumber ' 1 Mechanical Roofs 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 R has been paid and issued.
Applicant: /� ( L _
' ' � `"� � SignatureDate
Print Name:
Rovlolm "to ZW201 r