HomeMy WebLinkAbout2302 Owens Ave - Applications/Water Heater - 07/24/2018i Planning, Development, & Transportation Services
Ott 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
manufacture \
Complete all applicable information on the application.
Application # q0b (Q I --�
for office use only
Incomplete applications will not be accepted.
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Date I ;%,
Job Site Address (required) i p Value of Construction (labor, materials, profit)
2502 ub (,,) (M _r4 . �c&,*,)0 & 1 b-91- (5149 - GCS
Property Owner Name Address
� 1 � r1 Gty/StPate �Ziiplj� (� 7 Phone 0470
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Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
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V; Y d V ry-1 o RQ2
Contractor City of Ft ollins Sales ax # Are you paying taxes here or by report? ere ❑ Report
Sales tax number is required by all con" ors Are you paying with your trust accoun ? Yes ❑ No
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: ngle 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 Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work W1 c, (�� 3 6, a 0g rLr
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& the company name or Crty of At Collins license Jf
Electrician 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.
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Applicant:
Print Name: /r. % '1 t ! ^ (Si nature Date 1;7
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Revison date 2162017