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HomeMy WebLinkAbout1225 W Prospect Rd - Applications/Water Heater - 02/20/201303/04/2010 0 4 : 0 8 #0621 P.001 /001 This application is to be us ❑ Demolition (interior non-stt ❑ Heating Unit ❑ wn Spr 0 Ventilation Vater Heato manufacturer). Complete all applicable info Application #t1-f3QC Foroliioe use Planning, Development &Transportation 281 N. College Ave P,O- Box 580 Fort Collins, C_O 80524 Phone 970-416-2740 Fax 224-6134 to apply for the following permits only (check all that apply). ❑ Air Conditioning tural) ❑ Electrical Alteration (not service change) © Gas lighter ❑ Gas Log :ter ❑ Mobile Home replacement C] Roofing ❑ Sewer line ❑ Photo -voltaic O Water line Q Wood/Pellet Stove (must be EPA certified, provide make, model and on the application, Incomplete applications will not be accepted. k`w Date (;2 a O Sob Site Address (raqu/rad)j U-f) If it Value of Construction (labor, materials, profit) laas Lk-1 g $ s Property Owner Name Address City/State Zip Phone jjffliS 330 R7 i2d - )MOOid tvIRD-33 Applicant Name Address City/State Zip Phone r P CO '905DI0 quo ao A(29 con ctor c Address City/State Tp Phone Gtrl'i t° Co ctor City of Ft GDAIns Sales Tax # Are you paying taxes here or by report? CI Hffd Report -%4ey oaxnumf 117na,aursrt3'a# 6ntralzom Are you paying with your trust account? D4es Cl No Is this a residential or oomme If residential, Is it: ❑ Sing! © Murd If commercial, is it; Q Bank ❑ Resta Is this building 50 years of a If this is for a demolition .pe 7fprior to 1975, yvu W71 nee6 of work *If lawn sprinkler/beclflow 5uboontractors: U6t the i Q7,; ial project? Mesidential © Commercial Family Detachedondo/townhome (single family attached.) ❑ Duplex nily (apartment) '�j Garage 1 ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 0 Office Q Retail ant ❑ Other (explain) e or more? Q Yes ❑ No YPy ,, you may need to contact Historic Preservation nit, what year was the building constructed? in asbestx assessment M submit wiM this appllCalion. r, must list licensed plumber. If first-time A/C, must list licensed electrician - name or Ody of Pt Cabins //ceose # Mechanical Roofer __ Other I hereby acknowledge that I hake read this application and state that the above information is complete and correct. I agree to comply with all requirements cdntained herein and city ordinances and state laws regulating budding construction_ I know that a permit Is not valid until it Is been paid and issued.. Applicant~ Print Name: Signature /y^- Dale xh�