HomeMy WebLinkAbout5220 Boardwalk Dr - Applications/Water Heater - 10/02/2013Oct 01 13 10:14a Rues. LLC
970-619-8074 p.3
F6City of Planning, Development & Transportation
r�t Collins 281 N. College Ave P,O. Box 580
Fort Collins, CO 80524
Phone 97C-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This appfication is to be used to apply for the following permits only (check all that apply), Q Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler Q Mobile Home replacement ❑ Roofing ❑Sewer Line Q photo -voltaic
m Ventilation Q Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). �
Complete all applicable information on the application. incomplete a I• /
I;
Application # E3 i 3d s t -7q
Foroff/ce use amy
Application
Job Site Address (required)
Property Owner Name
Applicant Name
'7c•" Li: r .3 V
Contractor
Address
Address
Address
�i
Contractor City of Ft. Collins Sales Tax #
Sale, ear number is required by a// ro trscYars.
l
pp
will not be accepted.
Date U a - 13
Value of Constructi n (labor, materials, profit)
—� �1,�o��ltx�
Zip Phone -
`
City/State Zip
City/State Zip
< LY
Are you paying taxes here or by report? ❑ Here
Are you paying with your trust account? El yes
Phone
Phone
Ea Report
Q No
Is this a residential or obmmercial project? Residential 11 Commercial If residential, is it: 5 ngle family Detached ❑ Ccndo/townhome (single family attached) E] Duplex
❑ Multifamily (apartment) ❑ Garage
If cornmercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical' office ❑ Office ❑ Retaif
❑ Restaurant 11 Other (explain)
Is this building 50 years of age or more? 0 Yes ❑ No If yes, you may need to contact Histonc
If this is for a demolition permit, what year was the building constructed? Preservation
IfPnor to 197S, you wi/1 need an asbestos assessment to submit with this appifcatjon
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L&thecompanyname orCity ofFtCo//ins license #
Electridarl— Plumber. MechanicalRoofer
—_ 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 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.
Applicant: —i.
Printdame:'ri-1
signature ` -._ M1 Date I i _ i �3-
1