HomeMy WebLinkAbout912 Bitterbrush Ln - Applications/Water Heater - 12/21/20120
PWnind, Development & Transportation
281 N. CAllege Ave PO. Box 580
1 i Fort Collins; { O 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). 0 Alt Conditioning
0 Demolition (interior non,stnrctural)' C]_ElectricafAlteration (not service change) .❑ Gas Lighter O Gas.Log
O Heating Unit Olawn Sprinkler 0 Mobile Home replacement 0 Roofing ❑:Sewer line . O Photo -voltaic
O Ventilation K Water Heater 0 Water Line O Wood/Peilef Stove (must be EPA certified provide make, model and
manufacturer).
Complete all applicable information on the application: Incomplete applications will not be accepted.
Application # Z_ _ Date
—_V? -`
FoivJilce use only
r
lob Site Address (requlW) Value of`c nstrUctlon'(labor, materials, profit)
9.1, 4e s �.,R r, t 5 00 . d
Property 0ivner Name Address city/state �� up eos2b Phone
Ll�.Jf s 9,.�f53-9?8'i_.
,Applicant.Name Address aty/State ` Zip phone
contractor Address City/State'` i Zip Phone
fir► d, x� \ 2�- e� 303 9.9y-357
Con qo' r Gty'of Ft. Collins Sales Tax # Are.You paying taxes' here or by report? O Here 0 Report
Sales lax number Isrequlydbyaliron&acrorr.. Are you paying with your trust account?. O.Yes . Q No
Is this a residential or commercial project? Rpsidential' ❑ Commercial
If residential; is it: mgle Family Detached 0 Condo/townhome (single family attached) 0 Duplex
Multifamily (apartment) . O-Garage,
If commercial, is it: ElBank 0 Bar .O t hurch 17 Hotel/Motel O'Medical office [3 Qffice ORetail
Cl. Restaurant ❑ Other (explain) .
Is this building 5o years of age or more? ❑ Yes ,CNo byes, you mayneeY to. contact H14tq Preservation
If this is for a deinolitionpermit, what year was the building constructed?.
Ifprlor to 1975, you w111 need an asbestos assessment to submit with th/s.application.
_ Description of work =ns ll;t� rJgv is n
*If lawn sprinkler/backflow preventer; must list li ensed plumber. If first-time A/C,.must list licensed) electrician.
Subcontractors: ListthecompanynameorC4YFtCo111ns1lcense
Electrician: plumber Mechanical }I_I�F 2 Z' Roofer I 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 regulatinq building construction. i know_that a
" permit is not valid until it has been paid and.issued..
Applicant: I t• .
Print Name:-�c 016
V S =✓b 1AVl Signature' . \�J Date 1 2 ? �� Z