HomeMy WebLinkAbout4014 Bracadale Pl - Applications/Water Heater - 08/14/2019City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins. CO 80524 Main: 970.4162740 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 tine ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA cerlified, provide make, model and
manufacturer).
Complete all appfirab�rfoJrmon on a application.
Application #_��
Form car a*
Incomplete applications will not be accepted.
Date August 14, 2019
Job Site Address (required) Value of Construction (labor, materials, profit)
4014 Bracadale Place, Fort Collins, Colorado 80524 $2129.00
Property Owner Name Address City/Slate Zip Phone
Jose RaY9oza 4014 Bracadale Place Fort Collins, CO 80524 970-484-1314
Applicant Name Address Clty/State Zipp Phan
Christina Evans 1015 Link Lane Ft Co, CO 80524 494-7632
Contractor Address Clty/State Zip Phone
Allen Service 1015 Link Lane Ft Co, CO 80524 484-484I
Contradnr City of fi Collins Sales Tax # Are you paying taxes here or by report? ❑Pere ❑ Report
'Wes tar nwndri&reprrrredbyaffcordracftm Are you paying with your trust acmunt? VYes ❑ No
10010
Is this a residential or wmerdal project? Residential ❑ Commercial
If residential, is R-. ` l 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 ❑ No kyer;, you nrayneed to contactffistoricAessnabr w
If this is for a demolition permit, what year was the building constructed?
Description of work "' m""' wM and `1q rich b s1m w/H
*Tf lawn sprfnkler/baddlow preventer, must list licen%d plumber. If first-time A/C, must fist licensed electrician.
Subcontractors: Lit Mecuigwpyname orOWafftCoNnslicerc #
Electridan Pkmhber Med=1caf Roofer Othher
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 mnstrudion. I know that a
permit is not valid uritil it has been paid and issued. [slim
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