HomeMy WebLinkAbout1327 Saint Croix Pl - Applications/Water Heater - 11/23/2018City 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 1(I
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 # e) 111®4 d 0( Date il�zrn I I
For otrice use only
Job Site Address (required) Value of Construction (labor, materials, profit)
I R. ��Ut� Cd p65a5 �1�32- CSZ�
Property Owne Name Address -, D' City/State Zip Phone
13 7 ' V l- F f M R(OS25 0t'7otPV-
ADplicant Nam _ Address City/State Zip Phone
7 y t� ,(?�i1� Cj0 grlL-z9 ate-zap-s��s'
Contractor Address City/State Zip Phone
d , ZW wCG x) 303 -� -S7�5
Contractor City of Ft. CollW Sales -I ax # Are you paying taxes here or by report? Here ❑ Report
Sales tax number is required by all Are you paying with your trust account? es ❑ No
Is this a residential YMultifamily
mmercial project? , Residential ❑ Commercial
If residential, is it:Single Family De ❑ Condo/townhome (single family attached) ❑ Duplex
(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 may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
1
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: V
Print Name: �QUP Signature Date
19
Revision date 216/2017