HomeMy WebLinkAbout919 DEERHURST CIR - APPLICATIONS - 5/9/2018City of Planning, Development, & Transportation Services
Flirt Cotti s Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 970.416.2740
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 Line ❑ Photo -voltaic
❑ Ventilation XWater 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 # ` Date May 9, 2018
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
919 Deerhurst Cir $2200.00
Property Owner Name Address City/State Zip Phone
Seth Troy 919 Deerhurst 970-566-3217
Applicant Name Address City/State Zip Phone
Daniel Ormesher
Contractor Address City/State Zip Phone
Independent Plumbing Solutions, Inc. 1611 E Lincoln Ave, Unit A, FC, CO 80524 970-566-1377
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Xl Report
sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes E:kNo
45189
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: X 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 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 Replaced water heater with a new power direct vent water heater
*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 M P610 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: Daniel Ormesher Signature Date
Revised 11/23/2016