HomeMy WebLinkAbout506 Charrington Ct - Applications/Gas - Log, Line, Pipe - 04/24/2013APR-24-2013(WED) 14:27
P. 001 /001
FCity of
lirt C0ltins
Planning, Development; &Transportation
281 N. College Ave P.O. Box S80
Fort Collins, CO 80524
Phone 970-416.2740 Fax 224.6a.34
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). Air ' ing
Demolition (interior non-structuran Electrical Alteration (not service change) Gas Lighter �s Log
Heating unit Lawn Sprinkler Mobile Home replacement RooOng Sewer Line Photo-vo a c
Ventilation Water Heater Wat Li W
manufacturer).
er ne aodlpellet Stove (must be EPA certified, provide make, model and
Complate all applicable information on the application. Incomplete applications will not be aCCepted.
Application # 0 c6��
t3Date Ll—V-1-12
AV ofJ7oD M only
is this a residential or common Residential Commercial
If residential, is it gl Family De hed ndo/townhome (single family attached) Duplex
Mu drtment) Garage
If commercial, is it: Bank Bar Church Motel/Motel Medical office Office Retail
Restaurant Other (explal
Is this building 5o years of age or more? Yes No Eyes, you rrk7ygctcd to tented Hlswrk p ryPtjm
If this Is for a demolition permit, what year was the tng constructed?
lfprfor to 1975 ),pu Will nftd do asbestrxs ,9 sxment tv,5M&Wt With this oppGGsdan.
Description of work
r i c..., t
sr-"r
'If lawn sprinIder/backflow preventer, must Iist licensed plumber. it firg.dme A/C, must list Iicensed electrlelan,
Subcontractors: Z'st Me Company ndme orOty of Ft Calrar. kcem a A'
Sectrlelhn. Plumber
_ Mcdumlral P=rer. Other.
I hereby acknowledge that I have read this application and state that the above inrormation Is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that; a
Permit Is netvalld until It has been paid and Issued.
Applicant:
Print Nance; �' Signature paw �'-1