HomeMy WebLinkAbout1227 Belleview Dr - Applications/Gas - Log, Line, Pipe - 10/24/2013OCT-16-2013(WED) 15:18 P.001/001
City of planning, Development & Yransportation
281 N. College Ave P.O. Box 580
F„(5rt Collins 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 WoodlPellet Stave (must be EPA ceriifled, provide make, model and
manufacturer).
Complete all applicable information on the application. incomplete applications will not be accepted.
Application # &3C)S(P i 'f Date - 1 b��- 13
Faraffke asr any
Is this a residential or oam aesldentfal . Cammerdal
If resldentla10 Is it: Single Family Deta n o/townhome (single family attached) Duplex
partirient) Garage
If commercial, is It: Bank Bar .Church Hotel/Motel Medical office Office • Retail
Resmurant Other (expI in)
Is this building 5D years of age or more? Yes No 0y= you May need to contact H/stonc ftservytlari
If this Is for a demolition permit, what year was the -building constructed?
l(prior to d97F, YOU will need an asbestos assessment to submit with this application. /
Description of work` N S� ke -Tf �¢e t4 DI N,p, � -(-p WD 4 ft66AVv vNy- � N N_ ±�r GAF, U �M �L),WA X— iZ� pjgjZ&:V .
-Ir lawn sprinklerlbackflow preventer, must list licensed plumber. If first-dme AM must list licensed electridan.
Subcontractors: 4& the 6ompany name or Clo, of Ft Collins G'Ccnse Jr
Bectrldanplumber
� Medwnlul _ ___ Roofer other.
1 neretry acknowledge that I have read this application and state that the above Information is Complete and correct. t agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction, x know that a
permit is not valid until it has been paid and Issued. place -uN,4A
Applicant; ri �i
Print Name. -& .t•�n CC Signatuur
Date -LSO OC:1;'� ('z^i