HomeMy WebLinkAbout4215 Trail View Ln - Applications/Water Heater - 12/24/2012i
I
Plannin j, Developm"l nt & Transportation
i + 281 N. College Ave P�0. Box 58.0
Fort Collins, CO 80.524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application. Is to be used to apply forth. following permits only (check ail that apply). O Air. Conditioning
❑ Demolition (interior nonstructural) O.Electrical Alteration (not service change) .❑ Gas tighter ❑. Gas.Log
❑ Heating Unit O Lawn'Sprinkler ❑•Mobfle Home replacement O Roofing ❑Sewer Line O Photo -voltaic
❑ Ventilation W[Water Heater ❑ Water Line ❑ Wood/Pellet Stove{must be EPA certified, provide make, model and
manufacturer).
Complete all appy ble. Information on the:application. incomplete applications will not be accepted.
Application # Date
Poi.offlce use only
Job Site Address ilrequlred) Value of Construction. (labor, materials, profit)
4215 - v4A View L:Avl-9- � ►'t5PO
Property Owner Name Address City/State C.
Zip Phone
lov'r,g1Hd. L•,�OM' P,,S ` ?-%S vn1`V.-w
R70-(a7c7 y56yI
Applicant Name Address City/State
Phone.
4 Zip71
Contractor Address city/Stake ` i Zip Phone
U P.d .Z 4-;
Con ractor City'of Ft. Co111ns Sales Tax # Are,you paying taxes here or by report? ❑ Here ❑ Report
sales: faxnumber srequi dbyalltvntractom Are you paying with your trust account7, O,Yes 0No
Is this a residential oe commerdal project? P(ResidentialO Commercial.
If residential, is it: . Single Family Detached ❑ Condo/tvwnhome (single family attached) O Duplex
❑ Multifamily (apartrnent) O,QG age
If conrmercfal, is it: i0 Bank ❑ Bar .a Church ❑ Hotel%Motel ❑ Medical office ❑Office p Retail
0. Restaurant. ❑ Other (explain) ..
Is this building 5o years of age or more b Yes klo tfyes, yad.mayneed to contacttilst90cPr'eservatlon
If this is for a. demtilitign.permit, what year was the building constructe..dl.
Ifprlor to 1975, you w1// need an asbestos assessment to submit with Uils.aplilicatlon.
Descrlption of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C,,must list licensed' electrician..
Subcontractors: List the company name or Gty of Ft Co111ns 11cense #
Electridan_ Plumber Mechanical �I ya`a Roofer T__ Other'
I hereby acknowledge that I have read this appficatlon and state that the above Information Is coriiplete and correct. I agree to. .
comply with ail requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit's not valid until it has been paid and Issued..,
Applicant: �Q
Print Name:1rtT Ian Signature Date /2 • /Z 1 -