HomeMy WebLinkAbout607 Saint Michaels Dr - Applications/Water Heater - 01/09/2020City of Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins, CO 80524
Phone 970-41616-2740 Fax 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 ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ 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 # &a gGba ( Date
For office use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
607 Saint Michaels Drive
0 6)
Property Owner Name Address
City/State Zip Phone
Christopher Maguire 607 Saint Michaels
Drive, Fort Collins, CO 80525 USA (970) 402-1777
Applicant Name Address
Citv/State Zip Phone
fnad 0 e Gu ft 4600 Innovation Dr. Suite 102 FortCollins CO 80525 970-399-9940
Contractor Address
City/State Zip Phone
Benjamin Franklin Plumbing 4600 Innovation Dr. Suite
102 Fort Collins, CO 80525 970-399-99 0'
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ e Ct-R�part
Sales tax number is required by all contractors
Are you paying with your trust account? es ❑ No
52310
Is this a residential or cogml'ercial project?
❑ Commercial
If residential, is it: ErSingle Family Detached ❑ Condo/townhome (single-family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/ e ❑ Medical office ❑ Office
❑ Restaurant ❑ Other(explai
Is this building SO years of age or more? ❑ Yes No 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 t G�'1' zyw. in t - 6 o ci p' - Ily `A Ho FT d
lYV Vlhli19 WDrvX
❑ Duplex
❑ Retail
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber 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: f I �m l kh Qi CIO C/ � Signature
Date
12/11/19