HomeMy WebLinkAbout1225 W Prospect Rd - Applications/Water Heater - 09/24/201310/04/2010 02:50 #0946 P.001 /001
plan iing, Develop & "transportation
city of 281 j 1. Zollege Ave P.O Box 580
Fort Cc Itin Forttins, Co 80524 Fx 224134
nh 70- 416-7-74a 6
(WE
-THE-COUNTER P
MITSONLY
This application is t
be a
to apply for the following, permits
❑ Electrical Alteration (not se
n
(check an�tG tas
change)
hter❑❑'GaS Log rnng
0 Demolition (interiornon-
0 Heating Unit 0
wn Sp
ctural)
nkler ❑ Mobile Home replacement 0:11
fing 0 Sewer Line
be EPA cedified,
0 Photo -voltaic
provide make, model and
0 Ventilation at
r Heat
r 0 Water Line ❑ Wood/Pellet Stove
n
ust
manufacturer).
complete all applic
le information
on the application: inowomplI&I
applications wil
not be accepted.
O
D 3� Da
Application #
For o
Ifte use
only
C: " Q -� L
of Constructio
5.0 r
(labor, materials, Profit)
Job Site Address (
fed
122 5
rOs
to
Zip Phone
Property Na
Address
`L
�J2Im\l-1,�1
,Owner
Applicant Name
Address
/
tate
'S(5
Zip Phone
to q70-� L0 �l>7q c
r
Co
is
Address G
I
fate
Zip . Phone
Con ctor City of Yin Sales Tax # Are you pa ' g taxes here orb report'? C1 M W Ref
sa/as tax num�15mq byronpadax Are You Pa with your trust ccount? ekes ❑ No
is this a residential o Comm
If residential, is it ❑ SiN
❑ Muh
If commercial, is it: 0 Ban
❑ Resl
Is this building 50 Y4 barS Of
If this is for a demo 'on p
,rfprior to 1975, yo will na
'ption of
5i
*If lawn sprinkler/
SubconrtractorS:
Bechidan
4 I hereby acknowle
Icomply with all rep
permit Is not va
Applicant:
Print Mame:_
10
gal project? o Residential . ❑ Comr
Family Detached lP�ondaltownhorr
imily (aparknent) ❑ Garage
❑ Bar ❑ Churcha Hobd/Motel 0
irant ❑ Other (explain)
le or more? ❑ Yes 0 No. If yes, yc
mit, what year was the building cOnstn
an asbestos aSSPssrnent W submit with
r, must list licensed plumber- If firs
name or City of ft Collins license #,
that I Have read this application and state that the
ments �ontained herein and city ordinances and st
inbil It been paid and issued.
Signature
Ingle family att
iicai office ❑
ay need to con
i?
applia9b'on.
A/C, must list Ik
Roofer
e information is
ws regulating b i
:d) ❑ Duplex
_e 0 Retail
Historic P>esww6on
electician.
Other
-te and correct I agree to
Construction. I know that a
Date 3