HomeMy WebLinkAbout2000 Pacific Ct - Applications/Water Heater - 10/02/2012Oct /02 12 10:32a Ha ifi;Piumbing 9704935325 PA
Cif of •
y Planning, Development & Transportation
Port
Collins 281 N..College Ave P.O. Box 580.
Fort Collins, CO 80524
Phone 970-416-274D Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following
0 Demolition (interior non-structural) 0 Electrical Alteration (nott ervice chang) its only (check aD Gas Lll that �gh erDC] Gas Log
oning
0 Meeting Unit { 0 Lawn Sprinkler .0 Mobile Home replacement ❑Roofing p Sewer Line ❑ Photo voltaic
❑ Ventilation 0 Water Heater O Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacrurer)
Complete all applicable information on the applicatioA. incomplete applications will not be accepted.
Application # bloz-dsr q / d .- - Fir oulce use only Date I
Job Site Address (required) Value of Construction (tabor, materials, profit)
PrMope+•ty Ownzr Na/1me �, Address
Applicant Name Address Zip
Qty.S6te
Phone
Contractor
/ i Address City/State Zip Phone
r, r.
Contractor City of Ft Collins Sa Tax # r�., a �-
��� nran�rts - --v- -^ • . r- r Are you paying taxes here or by report? fl Here XReport
I �Wred-Ya//a�npa�r� Are you paying with your trust accourit? XYes ❑ Nb
Is this a residential or commercial project?
al
If residential, is it: Single Family Detached 0 c.,dQ/tiow home (single family attached) p Duplex
artmen
If commercial, is it , ❑ Bank a ily 13 Bar O Church ❑ Hotel/Motel ❑ Medical office 13 Office 13 Retail
0 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyas, you mayneeorto cnntatt1Vs01i7Preservation
If this is for a demolition permit, what year was the building constructed?
If prior. 1975, you Wi/!need an asbestos assessment to submit with this aAcftatlon
work
CIF lawn sprinkler/backnow preventer, must list licensed plumber. Subcontractors: List the company name or afirst-time A/C, must list licensed electrician.
ty OFFtCns Jr/!tense #
Electrician Plumber MechaNcal
Roofer Other
I hereby acknowledge that I have read this application and state that the above Information Is complete and correct. I agree W
comply with all requirements contained herein and city ordlnances_and State laws regulating building construction. I know that a
permit is not valid until It has been paid and issued.
Applicant: f r��
Print Nama:•--�c Oi hit-[ J rC -
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