HomeMy WebLinkAbout2104 Stover St - Applications/Water Heater - 06/14/2019City of Planning, Developmen4 & Transportation Services
Fort CdWIS Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO80524 Main: 970.4162740Fax; 970224.6134
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 Q 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 informaattio�n( an the application. Incomplete applications will not be accepted.
Application # )1 L " Date June 14, 2019
For afte far only
]ob Site Address (requkw2 Value of Construction (labor, materials, profit)
2104 Stover Street, Fort Collins, Colorado 80525 $0.00
Property Owner Name Address City/State ZIP Phone
Thomas 5olie 2104 Stover Street Ft Collins, CO 80525 970-484-3070
Applicant Name Address City/State Zip Phone
Christina Evans 1015 Link Lane Ft Co, CO 80524 444-7632
Contractor Address aty/State Zipp 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? ❑ ere ❑ Report
Safes twmm;ieri!rreq&edbyadm*acwm Are you paying with your Ma account? VYes ❑No
10010
Is this a residential or Wrimercial project? iidential ❑ Commeiaal
If residential, is it V Single Family Deladred ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If mmmercial, is it: 13 Bank ❑ Bar ❑ Church ❑ Hob*Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No If yey you may need to coma& /Fatm* Presaery iffm
If this is for a dernofilion permit, what year was the building wnshucted?
Description of work rs� ex&n,y em and repkm %0h eke .w/h -.®,wry repk=m tnlc
*If Fawn sprinkleribaddiow preventer, must list licensed plumber. H fast -time A/C, must list licensed eleeb ician.
Subcontractors: W the cvrnmynameorGlyofftCoMnsframe#
Sectidan Plwnta Mechanical Roofer Other
I hereby adurowledge that I have read this appfimbon and state that the above information is complete and tarred I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building conubucdon. I know that a
pemuit is not valid urM it has been paid and issued. /1
Applicant: Chri4twta Evan f , rp�,�,� `x��r, )' j nX (' t�
Print Name: Signature ► ' p vf���/lM Date t ��