HomeMy WebLinkAbout3500 Carlton Ave - Applications/Water Heater - 03/26/2019City of Planning, Development, & Transportation Services
Fort 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 Kwater 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 # 6 10/0 1 U oa
For office use only
Date 3 f a� Zr I
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
{sdre�' 3s00carltonikue- Oki- art G1(1�5 Co -v's-�2 197o) s(o<S-23so
Applicante
Name Address City/State i5p,52 5- Zip Phone
v o-r a o a2 0-39 -99ya
Contractor Address City/State Zip 605Z5 Phone q7o -
oo r � ;
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 12 Report
sales tax number isrequircdbyall contractors. Are you paying with your trust account? Yes r3IVo
`fig �-3�—
Is this a residential or commercial project? g-Residential ❑ Commercial
If residential, is it: M:Llngle Family Detached Condo/townhome (single family attached) ❑ Duplex
L7 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? OYesoft 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 Re -e— EJC'Stiv, C),([o, C-k4e- QoA-erltfc�f�r'
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orCityofFtCollins license#
Electrician Plumber)I P E9 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.
Applicant: a G
Print Name: 1 tP EUMC signature;!44A" Date
Revision dale 2/6/2017