HomeMy WebLinkAbout4506 Maxwell Dr - Applications/Gas - Log, Line, Pipe - 10/01/2013OCT-01-2013(TUE) 11:05
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City of Planning, Development & Transportation
281 N. Fort Collins Fort Collins, CC) 80524llege Ave'D Box 580
Phone 970-416.2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for tho following permits only (check all that apply). Alr Conditioning
Demcgtion (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 Wood/Pellet Stove (must be EPA ceriilled, provide make, model and
manufacturer).
Complpto all applicable information on the agollcatlon. Incomplete applications will not be accooted.
Application #�Date 01 OCTW
For offkr use only
Is this a residential or co Resldenttal Commercial
If residential, is It: Single Famil Oct townhome (single family attached) Duplex
Mu am y (apartment) Garage
If commercial, is It: Hank Bar Church Hotel/Motel Medical office Office Retail
Restaurant Other (explain
Is this bullding SD years of age or mare? Yes No -tf >� nu mayneed to contact Histo c Prt~scrvadon
If this Is for a demolition permit, what year was the building constructed?
Ifprior to 197Y ynu will ndedan asbestos arssessmcnr ro submit with this appllcapon.
of work
'If lawn sprinkler/backnow prevenmr, MList list IIce sed plumber, if first-time A/C, must list Ilcen5ed electrician.
Subcontractors: Lisr rhr mpvrry name or Cky of l} Collins license r
�lectrlden Plumbcr Mechanical Adorer. Other
I hereby acknowledge that I have read this application and State that the above Information Is complete and correct. I agree to
comply with all requiremenir contained herein and city ordinances and state laws regulating building construction, z know that a
Permit Is not valid until It has been paid and Issued.
Applicant: .�.-�-,(�,� r
Print Name:-1 L��"ignatur Date �� �T 2.�C1(