HomeMy WebLinkAbout2224 Sheffield Dr - Applications/Water Heater - 05/31/2013City of Planning, Development & Transpo�ation
Collins281 N. College Ave P.O. Box 580
-.,.wort CFort Collins, CO 80524
�.-- Phone 970-416-2740 Fax 224-6134 N
4C
OVER-T IE-COUNTE,R PERMITS Ode LY
This application is to be used to apply for the following permits only (check all that apply), 0 Air Conditioning
❑ flemolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Q_f-lealing UniL 9 Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Phuto-voltaic
Q Ventilation aler Heater.❑ Water Line 13Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicablle'IInnfforrmation on the application. Incomplete applications will not be accepted.
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Application # �G ��j
ror office use only Odt2 '.. `3 l
Job Site Address freardred)
aaa 4 S he -4'
Prooerty Owner Mimi-
;' 0rMIA �e Ikon
Value of Construction (labor, materials, profit)
1d DR. r-c co �5a& AaH.00
Address
_ �50 AL12.
Address
City/state Zlo
7
Zip
Phone
Phone
Contractor Address. City/State Zip Phone
C qv
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? C Here XReport
Sak$ tax nvmberarequir;dbyvacmimcrors. Are you paying with your trust account?)KYes ❑ No • 4
Is this a residential or mmercial project- 9".4ntial ❑ Commercial
If residentiai, is' Single Family De 13Condo/townhome (single family attached) ❑ Dupiex
Multifamily (apartment) p Garage
If commercial, Is it: ❑ Bank 13 Bar 13 Church 13 Hotel/Motel ❑ Medlcal orrice ❑ Office ❑ Retail
C) Restaurant ❑Other (exk1faig)is this building 5o years of age or more? ❑ Yes o Ifyes, ynu may need to contact Historic Preservarion
If this is for a demolition permit, what year was thilding constructed?
If prior to 197S, you will ne^rt an asbestos assessment to submit w/th tt)4 application.
Description of Yyprk.6&40p 'I�
ESL_,. v
an,, bviinxier/Oackriol ppriev—enter, must Ilst licensed plumber. If first-time A/C, must'list licensed electrician. i
Subcontractors; ListrhecomMnynameorC/ryoffiCoiiinslicense AV
Electrician Plumber Merhanical 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. = know that a
Permit is not valid until It has been paid and issued.
Applicant:
Print Name: h2i�1 lJrl� 5lgnatur "r
L211 Date '
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