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HomeMy WebLinkAbout5220 Boardwalk Dr - Applications/Water Heater - 08/01/2013Sep,24. 2013 ' 3:29PM 9704844448 ALLEN PLUMBING&HTG No•4600 P. 4/7 City of F t CoHins Planning, Development & T tansao::3tior 281 N. College Ave P.O. Bw 580 Fort Collins, CO 80524 Phone 970.416-Z740 Fax 224-61=4 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check an that apph j. rr Fair Conditioning ❑ Demolition (Interior non-structural) ❑ Electricai Alteration (not service change) n Gas Lighter ate '- Gas Log leahng Unit c7 Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing 'D Sewer Line El.Photo-voltaic 0 Ventilation rVater Heater El Water Line Cl Wood(Peliet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will no: bs accepted. Application # �� Date rvr office use only I o b Site Addr s Ireoulred) yaiae Of COMS!~ UCdOtt (labor, materials, profit) 13GV3r60. Prooertv Dwrie Name^ Aodress GtylState Zia pn ne Applicant Name c2�Akc 4 @F i Rti Address .•r� Ci /Stite t Eff ?F none ..«6� Contractor Address G Y/State .�.tp ah�ne Contractor Cite of Ft Collins Sales Tax Are Vou paying taxes here or by report? Z.. =j=re XRepo,� Sales fax number c requke� by all wnfra�' Are you pa}Ming wl � your tru t account? !'�s ` !tiro ,_ Is this a residential or e- rnmer_ial profs �? ,a-�13 ntial Commercial If residential, is Single Family De K M Condo/townhome (An -ale iamily atta_-hed) r` Oupiex Multifamily (apartment) 0 Gara e 9 , If commercial, is it: 0 Bank 0 Bar © Church p Hotsi Motel 11 Medical QM4e • Q office L-1 Retaii 13 Restaurant L Other (ex 1 lai.n) ' Is this building 5 B years of age or morel oyes ,� No If yes, you rrar need tv contac7 Hixorlc Preseruatlon Ir this Is for a demolition permit, what year wac the b ilding constructed? !f pr(or to 19Ta, you will ne^1� asbestos assessment to subrrnr with 0;* application. Description of Wrk,fYjp(IQIS1' r! W& and 1117s*dj� ,0"'1 ,prinrcler(nacknow preVenter, must list licensed plumber. If first-time A/C, mush USt Subcontractors: bstthe company name orCryofptCollins l(Cense0 Electrician _ _ _ plumber McOwtira _ Roofer Other t hereby acknowledge that I have read this application and state that the above information L complete and correct. i ag-ee to comply with all requirements contained tleEein and cjNordinances one -,State laws regul8 Aq t701ipg constructio' perm)) is not valid until It h4s' been paid and issued, Applicant: Print Name: Signatur