HomeMy WebLinkAbout3820 Celtic Ln - Applications/Water Heater - 01/10/2013Jan 10 13 11:43a Rues, LLC
970-619-8074 p.1
Fort Collins
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 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
❑ 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 tA Water Heater ❑ Water Line ❑ WoodfPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 5-I WM?5 f 0 Date 1v j —(�—
For of v use only LQ5.. D _
Sob Site Address (required)
Value of Construction (labor, materials, profit)
31?(H)
9 la ov
Pr arty Owner Name Address
�o
Ctty/State Zip
Phone
e d 3�ao
t` $�
97� -I� 10
Applicant Name Address
�fec r 1 �QLrll!?'✓ 4015
City/State Zp
Ave Love z '30531
Phone RIO-
LP26-�451711
Contractor Address
City/State Zip
Phone (RG-45
ail urY�in 11'or�iC�i;� LLlevibin
� )w1`.c_, to LovLta-,,4 N) b05hA
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
to Report
salesraxnwnber;srequiredbyancanaact s
=-9i 9 7� i
Are you paying with your trust account? p Yes
O No
Is this a residential or commercial project? ErResidential ❑ Commercial
If residential, [sit: ErSingle Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it:. ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Ls this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contxt His; o c PreserraUon
If this is for a demolition permit, what year was the building constructed?
If prior to -1975, you wi// need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed etectrician.
Sub ccntracbors: Listthe company name or Gty or colfuzsIxense #
Bectrkian
Mechanical Roofe
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 Imow that a
permit is not valid until it has been paid and issued.
Applicant: (( `
Print Name L L. Y 1�� LiYlJ ✓ Signature -"'r Date
q57
71