HomeMy WebLinkAbout1913 Bronson St - Applications/Water Heater - 03/22/2019-FCity of 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 O 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 #.
b 1161i5�1
For office use only
Date
lob Site Address (required) Value of Construction (I�bgr, materials, profit)
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
f �c35' 97vsa��-97
Contractor Address City/Stat Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 04 iere ❑ Report
sales tax numberrs requlmd by all conboclows Are you paying with your trust account? ❑ Yes cli No
Is this a residential or commercial project? 4 Residential ❑ Commercial
If residential, is it: ❑ Single 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 O No If yes, you may need to contact HistoricPreservabon
If this is for a demolition permit, what year was the building constructed?
Description of work y
*If lawn sprinkler/backflow, preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Me company name orGtyofRCollins license #
Electrician Plumber b 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:
Print Name:/r/ot✓f�i�dr� Signature Date
Revis(en date 2/612017