HomeMy WebLinkAbout2804 W Elizabeth St - Applications/Water Heater - 06/17/201306-17-13;01:08PM;
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Planning, Development &Transportation
281 N. College Ave P,0. Box 580
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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on
onn the application. Incomplete applications will not be accepted
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Application # F/1' 26 ;/l 'ClCoDate 17 /t -a 1y�
fsv olfrce tde only
lob Site Address (repulrmg
Value of Construction pabor, materials, profit)
So W. 6:LIz0913F14 t
3500
Property Owner Name Address
City/State Zip phone
ppr:EptC A Je FF121 E aE04 W.2rtg6714+r l4-00L4I1JS CO 80SAl T'70 .C21-Si377
Applicant Name Address
City/State Zip Phone
Contractor Address
Clty/State rip Phone
IN fr 14 Faux 1554, Lcuer-AY.Ab Cd SU53 570 G0-4555'
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ,Here ❑ Report
snhs bxnumbwAr repulredbyaoeontractan:.
Are you paying with your trust account? *'Yes ❑ No
Is this a residential or commercial project? .Residential ❑ Commercial J s. oo w
If residential, Is it: OSingle Family Detached 0 Condo/townhome (single family attached) ❑ Duplex a5.ejo f-
a Multifamily (apartment) ❑ Garage G 7,3rr rn
If commercial, is it: 0 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ medical office ❑ Office ❑ Retail 16. so co
❑ Restaurant ❑ other (explain) I 177. 80 7a.
Is this building so years of age or more? Cl Yes ❑ No If yes, you mayneed to contact Hdstnr/cpreaervat/ar
If this is for a demolition permit, what year was the building constructed?
Zpriw to 1975, you wl//need an asbestos assessment to submlt w2h this application
Description of work Rf: PRcu 4o 6f41-GON WAT'&YZ 60d -6-FL)
-h4 0,aoo 76rr)
*If lawn sprinkler/baddfow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the cempanyname o^Oty offt t:olliru license #
Eleettidan Plumber Mechanlral Roofer Other
I hereby acknowledge that I have read this application and state that the above information 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 not valid until it has been paid and issued.
Applicant. /,
.
Print Name: SALLY Kt55ULAA4f44 Signature Xb'-d-4t-�N'GDate
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