HomeMy WebLinkAbout2524 Newport Dr - Applications/Water Heater - 04/15/2013I
Planning, �opnw* A Tmwwpw to CM
6rt of � College 8M4 P.O.
�.- Phone 970-416-2740 fax 224-604
OVER-THE-COUNTER PERMS ONLY
This application is to be used to apply fat #re foilotrft permits only (duck all that applll . ❑ Air Conditioning
❑ Demolition (trnerior rron-structuMI) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation WMater Heater 0 Water Line ❑ Wcoffellet Stove (must be EPA certified. Provide make, model and
manufacturer).
Complete all applies ie irrtnnnatlon on the appUra dom hux mplate apprications wig not be accepted.
Application # %i��Date
r4rar" rase a *
lob Site Address (r) Vahrecof Cmisb a�iarr (labor, materialsprctit)
Ti�Ti'i ew D z $ IDD.
Property Owner Name Address
Gty/State
. Zip
Phone
s �� Wd zs zy ,f Dk FGa
gGs�
dS175'� P
Applicant Name Address
(Sty/State
Zip
Phone
UC # Address
Contractor p�arnlii^9
/7
Ciilr/gtatie
ZIP
Phone
-it's, 13) A fiuc-ICSt
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here [WReport .
sales
Are you paying with your trust account?
&Yes B No
Is this a residential or commercial project? 07ResideriN .: Commercial
If residential, is it: ❑ 94e Family Detiched O Condo/tow ftme (single family attached) ❑ Duplex
13 Multifamily (apartment} 0 Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church O HoWMotel O Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
IS this building 50 years of age or more? p Yes Oft Y)e4)ovun7aynadtpcaWactHLquoicpleservWon
If this is for a demolition Permit, what year was the building constructed?
Ifprfar to 197'5, y¢w wW need an as &a awmnwtto m W& milli tYlfs4witm m
Desmption of work . < e-
C-
*If lawn sprinkler/U ddiow preventer, must list Doomed plumber If first -tune A/C, must list licensed dectncwL
Suboorrtrac ors:L&thecampanynameorOlyofftCoahsBxmL*,f
Bectridan Pkariber Msdwrdl Roarer.
Other
I hereby aclow4edge titat I ttave read this application and state that the above information is complete and correct. I agree to
comply with all rewrements ocritained herein and city ordinances and state taws relating bAcog conduction. I know that a
Permit, fs uwt valid until it has been paid and issued.
Applicant:
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