HomeMy WebLinkAbout723 Laporte Ave - Applications/Water Heater - 08/22/2018fCityot Planning, Development, & Transportation Services
ort 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 # Date August 22, 2018
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Job Site Address (required) Value of Construction (labor, materials, profit)
723 Laporte Ave, Fort Collins, CO 80521 $5,457,00
Property Owner Name Address city/state Zip Phone
Alok Jha 723 Laporte Ave Ft Collins, CO 80521 512.552.2706
Applicant Name Address City/State Zip Phone
Christina Evans 101 S Link Lane Ft Co, CO 80524 494-7632
Contractor Address City/State Zip Phone
Allen Service 101 S Link Lane Ft Co, CO 80524 484-4841
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑pere ❑ Report
Sales tax number is requiredbyal/ronbactom Are you paying with your trust account? VYes ❑ No
10010
Is this a residential or c mercial project? Residential ❑ Commercial
If residential, is it: 1W Single Family Detached ❑ Condo/townhome (single family attached) CI 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 Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Remove existing 50 gal water heater and replace with new npe-240a tankless water heater.
*If lawn sprinkler/backilow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orCityofFtCollins license #
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. ^�n"n (y
Applicant: i
Print Name: Christina Evans Signature\� i Date f/
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