HomeMy WebLinkAbout1985 Angelo Dr - Applications/Water Heater - 11/21/201211/21/2012 10:25 7208646419
LONGS PEAK ENERGY CONSERVATION 01767 P.002 /003
..a talantlihd, pevetopiriiet�t&TCansporCation
31 N, Wlcnge Ave Pltl. Box 5$0
. Fort.Coihns,-CO 805241 -
Phorie 970-416-2749 !Fax 224-61-14
OVER-THE-COUNTER PERMITS ONLY
This application is -'to be used to apply for the folidwWIT permits only (checkatl that apply). a AiC. Conditioning
❑ Demorlbon (ntedor rion-structuraiY O.Electrical Alteration (not servioe change) ,[3 Gas t<igttfer 13 Gas.log
O beating Unit U lawnSprinkler O Mobile -Homer eplacement q Roorog DSeyleT Line CJ Photo-voitaic
❑ Ventilation [i Water Heater Ct Water Urle • 0 WopolPeltat'Stove (must be EPA QW6114—p.rovide make, model and
manufacturer). .
Complete all applicable. iihformatioh on th¢ application. Irtcomplete applications Will not be accepted.
Appllcatiort it I �` O �. 0 Date I I a
FOrriffice use-orrly
,. Job Site Address (requftvy
Value of Constr=66h (labor; materials, Profit)
l 9 55 �4 vn er)o
i�r IV AL
�' N�� oo .c�a
Properly Owner Name
Address
CItyJStaie- Lam: rP Phone
L;�Z V. t �n►�4
) y 95 A
j
►o S.VrvG �, c 'b%S 97o-SSA-�Z
Appllcant Name
Address
C1ty(State" ` 71p Phone
Contractor
Address .
Ci Wgta3,e.,. i 7jp Phone 357e,
Contractor Gity'of Ft. Colilns SalesTax #
Sale tarncimberLsrep ��edbyal/mnlradw5 .
Are,yoti paying to el here or' by report? Q Here d Repo
Are you paying With your tust a=ubt? 0 Ye5 17 Flo,
Is this a residential or cornmerdal. project? residential ]' Cvmifieraa3 • : '
If me identiai;'is it: 'ogle gamily Detached O Gondoftvwnhorne (single family attached) Q Dup[ex
C7 Multifamily (0parbrlent) O;Ga ag'e .
If com* merda I, is it; .M Bank 0 Bar .p`Church D Hotel/Motel 0,Medical-office b dffiee Q _Retail
Tllkstaurant d dther'(explain). .
is this building 59 years of age or more. O Yes P0 Ifyes, you may heed to contact y�n� preservadon'
If this is for a derrrtilition`permit, what year was the building constructed?
Ifprlorto J975, you Wlfneed an asbestos assessment tn submit with tilis.applicatfon.
Description of
*11`1awn sprfnIft[babdiow preventer, must list licensed plumber. If first. -time AM,.Must lfsf
electridan.
Subcontractors: List the company name orClyofF?Col6nsGcensc#
Elecuidan Plumber _ Mechanical' W ^r`! a'� irae�fer Ocher
I hereby acknowledge that I have read this appfication and sbke'Lhat. the above W,0o ratlon is pmplets apd correcC• I agree tp: ,
comply with all requfcementscontained herein and city ordinance§arid state laws �.9 lating .building,construCtt6n. Z kndw:that a
permit ts'not valid 6ntii it has beer' paid and Issued..
Applicant: •.. � . l .. pate
Print Name:+. CVtA 11�s � 10�n signature
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