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HomeMy WebLinkAbout2618 Bison Rd - Applications/Water Heater - 07/26/2013From (303) 583-8348 Fri 26 Jul 2013 09:13:33 AM MST MST Page 2 of 2 °" �,. I LU Fort colrriS, CO 80524 f Phone 970-116-2740 fax 224-b134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following parntits only (eiseck all that apply)..0 Air Conditioning • Demolition ;interior non•, structural) 0 ;Electrical Alteration (not service chango) 17-1 Gas Lighter Cj Gas Log • Heating trait. U Lawn Sprinkler a tNlobiie Home replacement 0 Roo-fing L Sewer Line 0 Ph•)tovoltaic Ci Va::t-atio: 0 water Heater u ;;,later Line 0 UV00s:1peliet Stave (must be EFTA ceniffe , Provide make, model and manufacturelo- Compiete all applicable information an the application, Incornplvte applications will not be accepted. Application # 7 —1 V . matt 7 0 _ > :br offic use en7sr Mats S ke Address {`raipAred) Value of Construction !labor, materials, profit} Prop" Owner Name Address City{; State Zip p?io; e q—kO- Applicant: Name A&-ress city/State. Zip Phone C zntraLt0r Address City; State Zip (t L ' pia_ -f -C- Q i .. r+. _.. , • sill :.. -.... sir % '3si!? O Contractor Cigar of Ft. Collins Sales T,c-V ...... Ara you paying tar..es hem or by rep3rf? eHe. e o P.eport Sv s tax pum-lier;.P waf..n5�f by 7an. Are yoU paying with your Trust account? J Yes C"No is this a resit ential or commercial prglectr Pesidersiai 0 Commercial if rPs'sientiai, is it: El Single F am;lye s etadied © Ccndeitownhome (simple farnily attached) Cl Dupiex n Muitifarilliy "aparinnzentj 0 Garage `f commercial, is it: El hard: 0 3ar O Church 0 Hotei f�lctel 0 Medical oltt -e CI Of?ice .0 €retail 0 Pesieurant 0 Other "explain) __— .....__..._.._. 1s this building 0 yeats of age or more? 0 Yes . 0 No V yt_s, you r,h?K oned to cvntaci Hiswlc preservatmn 1F this is for demo€Won permit, what year was Lbe building constructed? If print 1:7.1975; YOU W14, !Ie6l 30 354V9W 5 <355C?'snmen . fo submit w tb this 3pjolt aPon, Oi work '*if iawn sprinl-leribackfiow preventer, must list licensed plumber, If first-time A/C, must list licensed efectridan. Sutdctlntrattws: Gist the company r:-nie or City of Fc (Niins A. -an -so tk EiecGidail ?lams r------------ hletnar, a3 _ .. _ Roofer Other T hereby acknowledge that. T have read this applicatipn and stag; tnat the above Inforrnativ Is rvmplete and correct. 1 agree u. tnmpty with all requirements contained herein and city ordl nancns and s;Lte iatvs regulating bni;ding construction. I know that: e Permit is not valid until It has been pairs and issued. ._ iarirzt Plarxtex� ` -:., � �i>_ A wa.' 4 Wi�_l_