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HomeMy WebLinkAbout2730 Canterbury Dr - Applications/Water Heater - 07/31/2013From (303) 583-8348 Wed Jul 31 13:43:19 2013 PAST Fort Colliris, O 80524 Phone 970-416-2740 Page 2of2 Fax 224-6134 This Application is to bG usGd to apply for the following parrhite only (check all that apply). Gt Air Conditioning 0 Demolition (interior non•structurai) 0 Electrical Alteration (not service change) 0 Gas tighter 0 Gas Log 0 Heating unit 0 Lawn Sprinkler 0 Mobile Home replacement U Roofing 0 Se•,#er line Ct Photo-vojtaic ❑ Ventilation Q Water Heater l i Water Line Q Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). . Complete all applicable information on the avolication. Incomplete applications will not be accepted. Application Date �- _ _- --- L-__�-- 1=br of%v use Only f 30h 56 Addressl (.W Value ukec� of Construction (tabor, materials, ;profit} Properrr Owner Na me Andress CltyJState Zip Phone CC�0- _f Applicant Name _ address OtyjSvate - . Zip phon8 • I W i Contractor Address City/State Zip o Q 1AQ� %-k CA 491i(J) W, it 1S iL I-LCJl+✓e it ' ivci `. ove (G , ROSSI Contractor. City of Ft. Collins Sales Tix - Are you paying fixes here or by report? nHere C] Report 5ak-5 &A' f.Wlbe--f iS f MA/ wd by5/1 croftGtam Are you paying SViti'i your, trust; aCmunt? M Yes ONO Is this a residential or commercial project? V5Residential 0 Commercial If residential, is it: 13 angle Family Detached © Cbrdoltownhome (single family attached) ® Duplex Cl Multifamily (apartment) C€ Garage If commercial, is it: 0 Bank U Bar 0 Church 0 Hotel/motel 0 Medical office 0.. Office Ci Retail 0 Restaurant Ct Other (explain) --•------------------- - Is this building sQ yrears o€ age or mare? O Yes .0 uo If yes, you awyfr eed iv contact H...kstoilr Pres rvation If this is for a dern(Altion permit, vrtrat year was the building constructed? _ If prior to 1975, you ti+fiil need an asbestos assessnw?t to submit with this application. Description of work *If lawn sprinklerlbackliow prevent'er, must list licensed plumber. If first-time q%C, must list licensed electrician. subcontractors: L&t Lire cvmpovyrrame or City of wilts firense 9 Efectriddn plumber Mechanical Roofer Other I hereby aclat ywledge that I have read this application and state that the above information is complete and corm, 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. wpplicar= I-- t r f. Print Wamc �� jj i � t ' S�Jgna2cey�7 %` ` ;� r� f-- � t' _ bato ��