HomeMy WebLinkAbout2003 Mesaview Ln - Applications/Water Heater - 12/19/2012DEC-18-2012 13:31 From:Allen Service 970 484 4448 To:92246134 Pa9e:13,'16
City of
�F6rt Collins
Planning, Development & Transportation
281 N. College AVe P.O. Box S80
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). O Air Conditioning
O Demolition (interior non-structural) Q Electrical Alteration (not service change) ❑ Gas Lighter O Gas Log
O Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement O Roofing 0 Sewer Line .. ❑ Photo -voltaic
0 Ventilation Nne CI aler Heater O Water LiWoodlPeliet Stove (must be EPA certified. provide make, model and
manufacturer)
complete all applicable information on the application. Incomplete applications will not be accepted.
Application #
13 12-0-Iq3 2---
For office use on1Y
Date l a--lg-1 p- 12-I'
Job Site Address fremdreo7 value of Construction (tabor, materials, profit)
:2a03_ &.S41j;e14J )N. (__o f'o5�10 _ aggloo
Pr ertV Owner Nimp Address Citylstate Zlo Phone
%Illi�o f jar ik�,�n 56t
Applicant Namer Address City/State Zip Phone
%5 rri Lih�, Ua R. )I(Ah /cCi V5"24 Ao,.4$
Contractor Address CJty/5tate Tip Phone
A l lqj/l_�.r-1wriai Co wl54I
Contractor City of Ft. Collins Sales Tax 0 Are you paying taxes here or by report? O Here P(Report
Saks tax number /s regtrred by A# cnr tractors Are you paying with your trust account? A Yes O No
Is this a residential or mmerdal projedesidential ❑ Commercial
sid if reential, Is it: Single Family [3 Condo/to � nhorne (single family attached) CI Duplex
Multifanu'ly (apartment) O Garage
if commercial, is it: I7 Bank Q Bar O Church Q HoteVmtel I] Medical office • ❑ office O Retail
D Restaurant O Other ( fain)
Is this buikling 50 years of age or more? C1 Ye3 ,� No !t ye, yrw may med to contwe HistoHe Preservation
1f this is for a demolition permit, what year was the �ilding. constructed?
1f prior to 1975, you wr// nCelY�an asbcsim assesvrunt to submit wArh tft appJicabbm
Description of work
*If lawn sprinkler/backfkwv preventer, must list licensed plumber.: If first-time AIC, must list licensed electrician.
Subcontractors: Cyst the comawywnie of 01y ofRChNns/keme 0
Electrician PbUmber McChankal Roofer Other
I hereby acknowledge that t have read this application and state that the above Information is complete and correct. 1 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: " `�rr' e i gh Mgnatu Date